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Introduction

As professionals, parents and caregivers we want to provide the best care and support for Neurodivergent children and adults. Positive Behaviour Support (PBS) and Applied Behaviour Analysis (ABA) are often presented as effective interventions, so it is crucial to understand the concerns raised by many Neurodivergent individuals, advocates, and researchers. This guide highlights why these methods are problematic and explores compassionate and neurodiversity-affirming alternatives that align with best practices.

Why can PBS and ABA be problematic for Neurodivergent individuals?

Behaviourist-based approaches are considered problematic for Neurodivergent individuals because they focus on modifying outward behaviours to conform to societal norms without adequately considering the preferences, needs, or consent of Neurodivergent individuals or seeking to understand the underlying reason, motivation, or internal experiences – emotions, sensations, and thoughts of the individual. This dehumanises the person and leads to masking behaviours and suppression of natural and healthy Neurodivergent traits, such as stimming, which can cause intense distress and trauma, and negatively impact wellbeing. PBS and ABA do not address the systemic and societal barriers Neurodivergent individuals face.

What about PBS and ABA for people with learning disabilities?

Many of the concerns around PBS and ABA that apply to Neurodivergent people are relevant for everyone, including people that have a learning disability.Whilst there is, arguably, a stronger evidence base supporting the effectiveness of PBS for people with learning disabilities, there are significant concerns about the quality of many research studies (Pukki et al 2022). There still isn’t clarity on what people with learning disabilities think about this and how they experience PBS.

We believe that if something isn’t appropriate for Neurodivergent people, this is also true for Neurodivergent people who have a learning disability.

Our collective goal should be to improve life experiences and wellbeing, not modify behaviours to fit normative expectations – for all Neurodivergent people, including those with learning disabilities.

BSI (2022)

This is an extensive guide for building with Neurodivergence in mind. Whilst this guide takes the form of guidance and recommendations and should not be quoted as if it were a specification or a code of practice, it remains a detailed guidance on the sensory needs of Neurodivergent people wen working with buildings and shared spaces. Working with the widest definition of Neurodivergence, this guide explores inside and outside environments and a range of building types and sizes. Each aspect of a building is taken into account from lighting to walls and floors to ceilings, as well as soft furnishings and area layouts (such as open plan offices).

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van Grunsven and Roeser (2021)

Augmentative and Alternative Communication Technology [AAC Tech] is a relatively young, multidisciplinary field aimed at developing technologies for people who are unable to use their natural speaking voice due to congenital or acquired disability. In this paper, the authors look at the role of AAC Tech in promoting an ‘empathic turn’ in the perception of non- speaking autistic persons. Empathic turn means the turn towards recognising non-speaking Autistic people as persons with a way of engaging with the world and expression that are indicative of a psychologically rich and intrinsically meaningful experiential lives. The authors identify two ways in which AAC Tech contributes positively to this empathic turn. They outline how AAC tech can undermine genuine empathic communication between Autistic persons and neurotypical communicators. The authors suggest that AAC should be incorporate philosophical insights from Design for Emotions and enactive embodied cognitive science. Within the article the authors focus on stimming as an Autistic form of bodily expressivity that can play an important role in empathic communicative exchanges between Autistic persons and neurotypicals, with potential to facilitate in AAC Tech designed for Autistic people. 

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Delivered by El Dewar

Content Warning: Abuse, Child Abuse, Applied Behavioural Analysis, Electro-Shock Therapy, Dehumanisation of Autistic People, Gay Conversion Therapy, Physical Abuse, Grooming, and Coercive Control

This webinar explores the relationship between coercive control and ABA, through examining ABA’s history and current day positionality. The presentation explores issues surrounding common beliefs on ABA for Autistic people and the desire for, and damaged caused by, neuronormalisation. The latter part of the presentation focuses on the implications of compliance and control in ABA in the wider social and adult lives of Autistic people. Concluding with support methods to replace ABA, this webinar offers a Neurodivergent-affirming lens to the issues surrounding ABA outcomes and techniques with regards to coercive control.

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Disclaimer

At Neurodiverse Connection, we are committed to promoting the use of neurodivergent affirming language. However, please do note that in these webinars, as with any content that Neurodiverse Connection host or share that includes input from other organisations or parties, we cannot guarantee that the preferred neurodivergent affirming terminology is always used.

Our guide to neurodivergent affirming language is available here:

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Warda Farah (2023)

Early Years Educational Professionals need to be aware of the intersecting identities of the children they work with and their different needs and experiences. In this guide the author explores what it means to approach teaching through an intersectional lens. The guide also provides a practical approach to integrating intersectional practices into a classroom or wider school environment. The author stresses that with greater understand of students’ lives and lived experience, the greater opportunity for collaboration between teachers and pupils. This work takes a positive, empathetic and inclusive stance to intersectionality in Early Years Education.

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Pellicano, Fatima, Hall, Heyworth, Lawson, Lilley, Mahony and Stears (2022)

Content Warning: Brief reference without details to Sexual Violence, Self-harm and Suicide

There is little comprehensive research into Autistic adulthood, this limited research is partly because Autism is largely conceived as a condition of childhood. This focus of research has also come from traditional approach to Autism, which views Autistic experience almost entirely as a series of biologically derived functional deficits. Approaching Autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this review, the authors adopt an alternative research strategy. Through applying Martha Nussbaum’s capabilities approach, which focuses on ten core elements of a thriving human life, to research on Autistic adulthood. They identify areas where Autistic adults thrive and where they often struggle, and highlight issues. The authors state that it is far more complex than conventional accounts of Autism imply and stress the need to engage Autistic people in research.

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Milton (2018)

Content Warning: Applied Behavioural Analysis (ABA) and Positive Behaviour Support (PBS)

Written by Dr Damian Milton, the creator of the Double Empathy Problem, this report addresses the commonplace usage of Applied Behaviour Analysis (ABA) and Positive Behavioural Support (PBS). The article examines the criticisms of these widely used approaches and discusses why they are not supported by neurodivergent communities. The author concludes by detailing recommendations for future practices that move away from ABA and PBS to more neurodivergent-affirming support.

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gov.uk

The Access to Work scheme provides support for people with additional requirements to stay in work. It can help people with a physical or mental health condition, Neurodivergence (such as Autism or ADHD) or disability. Through the system you can apply for a grant to practically support you at work, support with managing your mental health, and funding to pay for communication support at job interviews. This website details what support Access to Work can give and the application method.  

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Pearson and Rose (2021)

The body of research on Autistic masking is growing and suggests that masking may be linked to negative outcomes for Autistic people. This work is a conceptual analysis of Autistic masking. The authors suggest that masking in a response to the deficit narrative surround Autism and the stigma within wider society. Through outlining classical social theory (social identity theory) the authors discuss how the theory can help understanding on how and why people mask. This is done through placing masking in the social context in which it develops. The authors explore the literature on stigma and marginalisation to explore the intersectional nature of masking – such as gender. They argue that whilst masking might contribute to differences in diagnosis, gender norms and stereotypes should not be imposed by associating masking with a female Autism phenotype. The article concludes with recommendations for further research – stressing the need for increased understanding of intersectionality and the ways in which Autism may present in different people. The authors recommend that masking is examined through a sociodevelopmental lens.

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Matzalas, Richdale and Dissanayake (2022)

This article proposes a theoretical model concerning Autistic Burnout, outlining the risk factors alongside the potential protecting characteristics.

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Dance and Ballestero (2022)

Educational environments can be difficult for those with sensory sensitivities. This article, aimed at both adults and children, focuses on sound in classrooms. It provides an introduction to the way sound is measured. It explains, in an accessible, clear and concise way, how building design can improve the acoustic quality in classrooms and other typically echoey and noisy spaces.

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RDs for Neurodiversity

In eating disorder treatment and recovery spaces there is often a focus on Intuitive Eating. For Neurodivergent people Intuitive Eating may be inaccessible for a range of reasons. This article outlines some of the reasons Intuitive Eating may be difficult and inaccessible for Neurodivergent people – including issues surround interoception. The article addresses these issues and suggests accommodations that need to be put into place to support Neurodivergent people in recovery.

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