Calm Is Not the Same as Regulated

A few days ago, I was sitting at my desk working with my dog tucked under my arm. Laptop open, emails being answered, work getting done, and a small furry colleague attached to me like some kind of emotional support handbag. Completely normal working conditions in my office, to be fair, but it got me thinking about regulation.

Holding my dog regulates me. The warmth, the pressure, the familiarity, the connection. There is something about having her tucked into me that helps my nervous system settle while my brain gets on with what it needs to do. For somebody else, having a dog climbing all over them while they are trying to work would be the absolute opposite of regulating. And that is really the point. Regulation is individual. Deeply individual.

Yet when we talk about regulation, particularly in relation to Autistic children and young people, we often still have a very narrow picture in our heads of what it should look like. Quiet body. Still hands. Controlled voice. Sitting nicely. Staying in the room. Following instructions. Looking calm.

But calm and regulated are not the same thing.

A person can look calm and be using an enormous amount of energy to hold themselves together. They can be sitting still while their nervous system is under huge strain. They can be smiling, speaking, making eye contact and doing everything expected of them while internally they are overwhelmed, anxious, overloaded or rapidly running out of capacity. As an Autistic adult, I know this from lived experience. There have been plenty of times in my life when I have looked absolutely fine from the outside while feeling anything but fine internally. I have smiled through panic attacks, holding each wave with the grit of my teeth beneath that smile.  I could continue the conversation. I could smile. I could work. I could be professional. I could keep going. From the outside, nothing looked particularly wrong. Inside, however, my nervous system could be working flat out. That is one of the reasons I have become increasingly uncomfortable with the way we sometimes judge regulation entirely by what we can see.

Calm is an external observation. Regulation is an internal experience.

Of course the two can overlap. A genuinely regulated person may look calm. But a calm-looking person is not necessarily regulated, and a regulated person may not look calm at all. They might rock. They might pace. They might hum. They might stim. They might curl themselves into a chair, wear headphones, leave the room, repeat the same phrase, seek pressure, avoid eye contact, move constantly or need to talk. They might look busy, restless or unusual to somebody else.That does not automatically mean their nervous system is dysregulated. In fact, the very thing that looks like dysregulation from the outside may be the thing helping that person stay regulated. 

This is where I think we need to be really careful, particularly in schools, therapy spaces and support settings. If we only recognise regulation when it looks quiet, still and socially comfortable, then what are we actually measuring? Are we measuring nervous system safety? Or are we measuring how easy somebody is for the people around them to manage? That is an uncomfortable question, but I think it is an important one.

For a long time, many approaches to autism support focused heavily on observable behaviour. Reduce this behaviour. Increase that one. Sit for longer. Stay in the room. Keep your hands still. Use an appropriate voice. Make eye contact. Tolerate the environment. Complete the task. The problem is that behaviour only tells us what we can see. It does not tell us the cost of producing that behaviour.

An Autistic child sitting quietly in a classroom may genuinely be regulated and comfortable. They may also be overwhelmed by the fluorescent lights, trying to block out the scraping of chairs, suppressing the urge to stim, worrying about what is happening later, rehearsing what they are supposed to say if somebody speaks to them and using a huge amount of energy simply to remain sitting there. From the outside, calm. From the inside, running on 2 per cent battery with seventeen apps open.

This is also where masking comes into the conversation. Research into Autistic camouflaging gives us very good reason to be cautious about assuming that what we see externally tells us how an Autistic person is doing internally.

Cook, Hull, Crane and Mandy's 2021 systematic review examined research on Autistic camouflaging and highlighted the complexity of the phenomenon. Camouflaging can include hiding Autistic characteristics, compensating for differences and developing strategies to appear more socially typical. Importantly, an outward presentation that appears socially successful can involve considerable effort underneath (Cook et al., 2021). That distinction matters enormously when we talk about regulation. If our measure of success is simply, "They looked calm", we may completely miss, "They worked incredibly hard to look calm."

More recent research strengthens the need for caution. A 2024 systematic review and meta-analysis involving almost 5,900 Autistic participants found significant associations between greater camouflaging and higher levels of anxiety, depression and social anxiety, alongside lower psychological wellbeing (Khudiakova et al., 2024).

The researchers are appropriately cautious about what this means. Much of the existing evidence is cross-sectional, so we cannot simply say that masking causes poor mental health. Recent longitudinal research has also highlighted how complex that relationship may be (van der Putten et al., 2025). But we can say that a substantial body of research is telling us that camouflaging is associated with mental health and wellbeing, and that encouraging Autistic people to become increasingly skilled at hiding signs of difficulty should not automatically be viewed as a positive outcome. That has huge implications for how we think about regulation.

Because if the adults around a child continually praise stillness, quietness, eye contact, compliance and their ability to "hold it together", while discouraging pacing, stimming, leaving the space or other visible regulation strategies, we need to ask what message that child is receiving. Are we teaching regulation? Or are we teaching performance?

Stimming is probably one of the clearest examples of why outward appearance can be misleading. Kapp and colleagues explored the experiences of 32 Autistic adults through interviews and focus groups and identified stimming as an important self-regulatory mechanism. Participants described using stimming in response to sensory experiences, overwhelming emotions and thoughts, and also described the social pressure they experienced to suppress it (Kapp et al., 2019). One participant described rhythmic movement as helping to "metronome" everything in their body. I love that description because it captures something really important. Sometimes the body needs movement in order to become organised. I feel that deeply, as when I present, I sway and rock in order to concentrate and keep my trail of thought moving in the right direction.  Sometimes regulation is not about becoming still. Sometimes it is about finding the movement, pressure, rhythm, repetition or sensory input that helps the nervous system make sense of what is happening.

Further research supports this. Charlton and colleagues examined sensory experiences and stimming across Autistic, potentially Autistic and non-Autistic adults. Participants described stimming as having positive regulatory effects, while suppressing stims because of social pressure could have negative emotional and cognitive consequences (Charlton et al., 2021). That matters, because if we remove the visible behaviour without understanding its purpose, we may not actually have improved regulation at all. We may simply have made the regulation less visible.

For one person, regulation might be pacing. For another, pacing would increase their stress. One person may need music. Another may need complete silence. One may seek deep pressure. Another may find touch unbearable. One may need to talk through everything that has happened. Another may need forty minutes before they can process language at all. One child may regulate through movement and proprioceptive input. Another may need to curl up somewhere quiet with very little sensory input. Neither is doing regulation "better". They are simply different nervous systems.

That is why I think neuroaffirmative practice has to move away from deciding what regulation should look like for somebody else. We can support people to explore what works. We can notice patterns. We can make environments more accessible. We can reduce sensory and cognitive load. We can co-regulate. We can help children and adults build awareness of what their bodies are communicating. But we cannot decide from the outside what should feel regulating to another person.

And we need to be especially cautious about removing a behaviour simply because it makes other people uncomfortable. If rocking is helping a person organise sensory information and we teach them to stop rocking, we may not have improved their regulation. We may simply have taken away their regulation strategy.

If a child leaves a noisy room because their nervous system is overloaded and we repeatedly insist that they stay so they can "build tolerance", we need to think about what we are prioritising.

If an Autistic person avoids eye contact because eye contact makes it harder for them to process spoken language, insisting on eye contact may increase their cognitive load.

If movement helps a child listen, requiring a still body may make listening harder.

The disappearance of a behaviour does not necessarily mean the need behind it has disappeared. Sometimes it simply means the person has learned that expressing that need is not acceptable, and that is where the risk of masking becomes very real.

Masking can look remarkably like success. The child who used to leave the classroom now stays. The teenager who visibly stimmed no longer does. The person who struggled with eye contact now maintains it. The child who protested now complies. From the outside, that can look like progress. But what if the internal distress has not changed?What if they have simply become better at hiding it?

Qualitative research into Autistic people's experiences of camouflaging has repeatedly described the significant cognitive and emotional effort involved. A 2024 meta-ethnography examining Autistic people's lived experiences of camouflaging and mental health found that people described substantial self-monitoring, exhaustion and negative consequences associated with trying to meet external social expectations (Field et al., 2024).

Other research has explored why Autistic people camouflage in the first place. Perry, Mandy, Hull and Cage (2022) proposed that camouflaging needs to be understood partly in the context of autism-related stigma. When appearing visibly Autistic carries social consequences, changing or concealing Autistic behaviour can become a strategy for navigating that environment. This is why I think we need to be very careful about talking about masking as though it is simply an individual Autistic behaviour. We also have to look at the environment that makes masking feel necessary. What happens when a child rocks?What happens when they leave the room?What happens when they say no?What happens when they communicate discomfort?What happens when their face, voice or body does not perform "calm" in the way we expect? Do we become curious? Or do we immediately try to change what we see? 

Sometimes what looks like improved regulation may actually be improved masking. If we repeatedly reward people for looking calm while overlooking how they actually feel, we risk reinforcing the message that appearing acceptable matters more than being safe.

For me, that is the heart of this conversation. I do not want regulation to become another performance Autistic people learn to get right. I do not want "regulated" to become a softer, more acceptable word for compliant. I do not want us to move away from overtly behaviourist language while quietly holding onto exactly the same goals underneath.

If the ultimate measure of success is still quiet, still, compliant, socially acceptable and easy for other people to manage, then we have not changed as much as we think we have. Neuroaffirmative practice asks something more of us. It asks us to tolerate difference. To become curious before we become corrective. To recognise that another person's nervous system may need things ours does not. To stop treating visible difference as evidence that something is wrong.

It also asks us to prioritise internal experience over external appearance. Instead of asking, "How do we get them calm?" perhaps we ask, "What helps this person feel safer and more settled in their body?" Instead of asking, "How do we stop the pacing?" we might ask, "What is the pacing doing for them?" Instead of wondering why a child will not use the calming strategy we have taught them, we might consider whether that strategy is actually regulating for them at all. Instead of saying, "They seemed absolutely fine in school", we might ask how much energy it took for them to appear fine all day. 

Those questions take us somewhere very different. They move us away from compliance and towards understanding. Away from correcting and towards curiosity. Away from teaching people how to appear regulated and towards helping them understand what regulation actually feels like in their own body.

Because calm does not always mean regulated. Movement does not always mean dysregulated. Compliance does not always mean safety, and behaviour never tells us the whole story.

Sometimes regulation is deep breathing and mindfulness. Sometimes it is rocking, pacing, humming, moving, repeating, retreating, connecting or being completely alone. Sometimes it is the same music. The same jumper. The same seat. The same routine. The same programme watched for the 476th time. Sometimes it is answering emails with a small dog tucked under your arm. The goal should never be to teach somebody how to look regulated. The goal is to help them understand their own nervous system, recognise what it needs, build ways of responding to those needs and feel safe enough to do that without shame.

That, for me, is what regulation should really be about.

References

Charlton, R. A., Entecott, T., Belova, E., & Nwaordu, G. (2021). “It feels like holding back something you need to say”: Autistic and non-Autistic adults' accounts of sensory experiences and stimming. Research in Autism Spectrum Disorders, 89, 101864. 

Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review, 89, 102080. 

Field, S. L., Williams, M. O., Jones, C. R. G., & Fox, J. R. E. (2024). A meta-ethnography of Autistic people's experiences of social camouflaging and its relationship with mental health. Autism, 28(6), 1328–1343.

Kapp, S. K., Steward, R., Crane, L., Elliott, D., Elphick, C., Pellicano, E., & Russell, G. (2019). “People should be allowed to do what they like”: Autistic adults' views and experiences of stimming. Autism, 23(7), 1782–1792.

Khudiakova, V., Russell, E., Sowden-Carvalho, S., & Surtees, A. D. R. (2024). A systematic review and meta-analysis of mental health outcomes associated with camouflaging in Autistic people. Research in Autism Spectrum Disorders, 118, 102492. 

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.