We believe that Positive Behaviour Support (PBS) and Applied Behaviour Analysis (ABA) are inherently flawed approaches, and that Neurodivergent people and people with learning disabilities, along with their families and carers, deserve better.
What is this campaign about?
We know that parents, carers and practitioners want what’s best for Neurodivergent people and people with learning disabilities. We do not judge anyone who has experienced or used PBS, but we know that better, more compassionate alternatives exist and deserve greater recognition.
Neurodivergent people and people with learning disabilities deserve better.
What are we against?
We are against PBS and ABA being considered the only options, the ‘default approach’. We are against the inadequate research base that props up the reputation and position of PBS, in the face of significant concerns from both professionals and the Neurodivergent community.
We are not against parents, carers or practitioners who have used PBS, believing in good faith that it is the best (or only) option.
What are we for?
We are for Neurodivergent-affirming therapeutic approaches. We are for considering the needs to the individual, not the societal constructs which they are expected to conform to. We are for compassion, empathy and understanding. We are for listening to the many voices within the Neurodivergent community who have been raising concerns about PBS for decades.
We are for better than PBS and ABA.
Why we’re against PBS & ABA
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PBS is not designed for Neurodivergent people who do not have a learning disability
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PBS and ABA are not human rights affirming
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PBS and ABA are not trauma-informed
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The dehumanising origin and development of the PBS model
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The lack of lived experience in the literature
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Concerns about PBS embedding systemic racism
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Concerns about the standards, consistency and impact of PBS
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Concerns regarding the quality of many research studies
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There are alternatives to PBS that are trauma-informed, Autism-informed and antiracist
Position statement summarising the evidence base on PBS
We are co-authors and signatories of the Culture of Care position statement on PBS, alongside delivery partners the Foundation of Nursing Studies (FONS), Black Thrive Global and the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) and lead delivery partner, the National Collaborating Centre for Mental Health (NCCMH).
An easy-read version of the position statement will also be available from June 2nd
Endorsed by
Add your voice to our campaign
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Dr Amy Pearson
Assistant Professor in Psychology
Centre for Neurodiversity and Development, Durham UniversityThis is such important work, and crucial to ensure that autistic people are being supported in a way that emphasises agency, choice and dignity.
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Charli Clement
Lived Experience Consultant
Pushing against widespread use of PBS is critical if we want to move towards systems which truly support individuals in a neurodivergent affirming and trauma-informed way - rather than paying lip service to these concepts. Neurodivergent people deserve something truly person centred that isn't harmful and isn't done just because it's become the norm.
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Sam Sly
Sam Sly Ltd
(Enough is Enough Time4Change)We, as human beings, all get unhappy, anxious, frustrated and rightly angry at times. Sadly, some of us suffer frighteningly traumatic times in our lives. None of us need to be given positive behavioural support at these times. We need understanding and love. Only do to others as you’d want done to yourself or the people you love.
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Ryan Boren
Creative Director
Stimpunks FoundationOur community of neurodivergent and disabled people includes those who survived PBS, ABA, and other behaviorist interventions incompatible with our ways of being. We fully support Culture of Care’s Position Statement on PBS. It articulates what we learned the hard way. Let’s save future neurodivergent people from misguided, neuronormative therapies. There are better ways.
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Dr Jay Watts
Disabled Person and Consultant Clinical Psychologist
I'm grateful for this position statement and delighted to support it. Behaviourist models like PBS mistake obedience for wellbeing. They smooth out difference and diversity, demanding palatability instead of presence. Autistic being is not a glitch to be corrected or a behaviour to be controlled. Neurodivergent people deserve care that honours our inner worlds—our rhythms, needs, and ways of sensing—not systems that reward our erasure. There are alternatives grounded in consent, dignity, and mutual respect. The SPACE framework is one such example, offering a path built on sensory safety, predictability, acceptance, communication, and empathy. The shift is long overdue—from compliance to connection, from control to consent, from surveillance to solidarity.
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Helen Edgar
Autistic Realms
I fully support NDC's Positive Behaviour Support (PBS) Position Statement, which highlights the incompatibility of PBS with neurodiversity-affirming, trauma-informed, and human rights-based approaches. In line with NDC, I advocate for supporting Autistic people by listening to their experiences, developing connections, adopting co-regulation strategies, and thinking of ways we can change the environment, not the person. PBS is rooted in behaviourist traditions, which suppress innate and authentic ways of being and have been proven to cause a lot of harm to Autistic and otherwise neurodivergent people. Like ABA, PBS prioritises compliance over well-being. We need to move towards care that honours and empowers neurodivergent ways of being and supports people to thrive without compromising their autonomy or erasing their authentic identity.
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Ann Memmott PgC MA
Research Consultant
We wholeheartedly support this Position Statement made by the Neurodiverse Connection members of the NHS Culture of Care Programme which includes many people we work alongside on a daily basis. As an organisation we at NDTi hold close to our heart our commitment to listen to people with living experience; if we don’t listen then who are we?We understand that many valued people and organisations we work alongside have invested heavily over time in developing their Positive Behaviour Support (PBS) skills and offer, however we cannot ignore the strength of feeling and mounting opposition from the real experts. Their concerns are those many of us as individuals have felt for some time.
We commend the Neurodiverse Connection in their writing of this Position Statement, not only speaking for themselves but the many who don’t have a voice. We urge all to pay attention, not to dismiss this Position Statement. Though it may challenge you as an individual or an organisation, please take note, and make a commitment to move on from PBS and embrace a more person-centred, relational, and experience cherishing approach to supporting neurodivergent people.
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ICARS
International Coalition Against Restraint and Seclusion
In 2019, the UK government issued guidance 'Reducing the Need for Restraint and Restrictive Intervention' which introduced Positive Behaviour Support (PBS) into education, embracing it as a methodology intended to reduce the incidence of restraint and restrictive practices in various settings. Yet there is no indication that PBS in schools reduces the use of restraint and seclusion. In fact across health and social care settings in England there is evidence that restraint use has increased since PBS has been widely implemented.Meanwhile there is an increasing body of research, information, training, and parent collaboration that promotes alternative, less discriminatory, person-centred, relational approaches that work. The autistic community’s experience of PBS needs to be heard. Effective systems designed to eliminate restraint and seclusion from our schools need to be informed and endorsed by neurodivergent and otherwise disabled people and they need to align with the UNCRPD, the UNCRC and Human Rights. ICARS fully support Culture of Care's position statement on PBS.
Within the ICARS report we have a chapter on Behaviourism and School Wide PBS.
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Julie Roberts
Therapist Neurodiversity Collective
Positive Behavior Support (PBS) enforces a profound power imbalance between those in authority and those who are vulnerable. In the name of normalization and cure, professionals and caregivers impose control over young and/or disabled people without their consent. The PBS model focuses on compliance rather than understanding behavior, forcing people to suppress natural, non-harmful actions and hide their authentic selves to meet the expectations of those in authority. This maintains an authoritarian structure that prioritizes behavioral conformity instead of dignity, self-determination, and well-being.Supporters of PBS must ask themselves: what other therapy routinely leads recipients to report violations of personal agency and bodily autonomy, psychological harm, and damage to mental health? What other intervention teaches autistic and other disabled children to ignore their own boundaries, mask their disabilities, and trade authenticity for conditional acceptance? These patterns leave individuals vulnerable to lifelong harm.
This concern is not limited to activists or self-advocacy organizations. A growing number of people who experienced ABA and PBS first hand are voicing serious objections to the harm they endured. Professionals are not the ones to decide what is or is not harmful to the people they treat. The people are. Providers who silence the voices of those directly affected, ignore their rights, and prioritize profit over ethical care are placing themselves on the wrong side of a human rights issue.
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Kieran Rose
The Autistic Advocate
As someone regularly commissioned to evaluate and risk assess PBS-dominated care environments, I recognise PBS, and its ABA foundation, only as frameworks of control and ‘perceived’ risk-management. They are rooted in outdated behaviourist traditions that prioritise compliance over well-being, that pathologise neurodivergent communication and behaviour as incompetent and dysfunctional, and disregard the autonomy, agency, authenticity and trauma experiences of neurodivergent people. These frameworks perpetuate neurological imperialism — the imposition of neurotypical norms as universal, positioning them as the standard against which all other ways of being are judged, controlled, and corrected, and use that as a system to exert power and control.Operating under the guise of person-centred practice, PBS is framed as a 'positive' and 'supportive' approach, yet rather than fostering true self-determination and identity expression it curates epistemic injustice and imposes arbitrary and ill-informed standards and expectations, with interventions delivered by practitioners whose understanding is too often limited to deficit-based narratives, rather than contemporary academic and professional knowledge combined with lived experience.
I fully endorse Culture of Care's call for a fundamental shift away from compliance-based interventions and a move towards approaches grounded in genuine person-centred care, contemporary knowledge, consent, and dignity, that prioritise the safety, agency, and humanity of Neurodivergent people.
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Kelly Mahler
Occupational Therapist
I fully support the Neurodiverse Connection’s Position Statement on PBS and its call to move toward truly respectful models of care. PBS claims to change outward behavior—but at what cost? It conditions us to override body signals and silence internal needs in order to comply, please others, and survive unfair demands. It teaches that comfort, regulation, and felt safety must be earned through obedience—rather than recognized as basic human rights. It sends the message that needs are only valid if they don’t inconvenience others. It insists that truth must be muted to be considered manageable, rather than met with curiosity, compassion, and respect.The irony? The name. There’s nothing “positive” about branding control and compliance as “support.” Responsible, ethical and affirming care centers inner curiosity and inner validation—seeing beyond the surface—and supporting people in understanding, trusting, and honoring the inner experience.
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Tricia Nicoll
Director
Gloriously Ordinary Lives
As humans we come in a wonderful assortment of difference – what a joy that is. Sadly, we operate in a world of health, social care and education that often seems to search for a ‘norm’, a square grey box to force us into. Positive Behaviour Support is one of those approaches that says it’s not about conforming, not about creating norms, but really is. I am so grateful for the work of Neurodiverse Connection in putting together this position statement and 100% support it. It will be tough for lots of people to hear as PBS has had such a huge investment across organisations. As someone who is all about Gloriously Ordinary Lives, I urge you to take a deep breath and have the courage to recognise that there IS a different, better, more human way of being alongside people - and spread the message far and wide. -
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Anna Lewis
Founder and Director
TogetherBetter Collaborative Consultancy
Our work with ND Connection has given me powerful insights into the lived experience of neurodivergent people and led me to a new understanding as to what helps and what is useful. It has also shown me the harm that is done when we fail to understand behaviour as distress. I am making a commitment as an ally to develop and share my learning and to use the opportunities I have to challenge outdated practice. I fully support the leadership that NDC has brought to this space, including this campaign and position statement. -
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Vicky Coxhead
NeuroHappiness
Founder and Director
100% on board with this! My degree and Masters was dedicated to this topic entirely. As an Audhd person and parent of neurodivergent children (now adults themselves) one also autistic with a learning disability, and someone who spent the last 2 decades working in the education and health system I am horrified and outraged that this behaviour modification approach is not only still being used but now seems to have ramped up a gear is is in force in pretty much all schools and residential homes and services. -
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David Gray-Hammond
Autistic Academic & Neurodiversity Consultant
DGH Neurodivergent Consultancy
PBS and ABA are based on a culture of normative violence and indoctrination into the belief that a small number of bodyminds are inherently more valuable than the majority. As a longstanding Autistic Rights Activist, researcher, and neurodiversity professional, I stand against the use of behavioural compliance techniques and advocate for a neurocosmopolitan society. -
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Bobbi Elman
Autistic Consultant and Coach
I am vehemently against Compliance training of Autistic/ ADHD / LD and Neurodivergent young people and children . ABA & PBS are not peer reviewed research based in any way and this compliance training leads to CPTSD, increased Anxiety and Mental Health issues as well as the potential for Grooming as it teaches the Autistic/ADHD/LD/ND person that they cannot say no to authority or perceived authority. ABA and PBS are Abuse -
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Victoria Rexworthy
Autism Support Advice
Autism and parent support advisorI fully support the petition against PBS and ABA, there are better neuro affirming supports and strategies that can change or adapt the environment for Autistic people and which don't try and change autistic people themselves, therefore allowing them to thrive and live authentic lives.
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Nic Crosby
Programme Lead – Small Supports
“If we don’t listen then who are we, and what are we doing?” However much time and money you may have invested in PBS in the past, take a moment to read and listen to what Neurodiverse Connection and their colleagues are all saying. If you don’t pay attention and you don’t listen, then you really need to ask yourself a few soul-searching questions.
alternatives to PBS and ABA
Time to ditch the carrot and stick
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Designed to address the unique needs of Autistic individuals, particularly within healthcare settings but the framework would work well across other sectors, including education.
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Designed to support Autistic young people by integrating insights and partnership work with Autistic young people, in addition to drawing on various established models.
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A guide to promote Autistic-led, autonomy-focused care for both children and adults in all care settings, including institutional environments.
THE MISSING EVIDENCE
Share your lived experience of PBS and ABA
The literature around PBS and ABA is lacking in lived experience from those who have received these approaches. We believe that considering lived experience is vital to establishing best practice.
Fill in this short survey form to share your story as part of our campaign. You can remain anonymous and specify the ways we can use your words.
our position
What about PBS and ABA for people with learning disabilities?
We believe that many of the concerns around PBS and ABA that apply to Autistic people are also relevant to those with learning disabilities.
Concerns include that the approach does not inherently support human rights, that there is huge variation in quality and design of delivery, and that this approach may be adding to harm, trauma, and distress. There are also significant concerns about the quality of many research studies (Pukki et al).
Whilst there is, arguably, a stronger evidence base supporting the effectiveness of PBS for people with learning disabilities, it is concerning that in over 40 years of practice, there still isn't clarity on what people with learning disabilities think about this and how they experience PBS.
Our collective goal should be to improve life experiences and well-being, not modify behaviours to fit normative expectations – whether for Neurodivergent people or people with learning disabilities.
NdC original resource
Guide to PBS and ABA
for professionals, parents
and caregivers
Additional PBS & ABA resources from our library
![[Autism] in Adults: Diagnosis and Management](https://images.squarespace-cdn.com/content/v1/632462bb88e23c400c82d41a/1684230316405-SAVJ3E11SH4GBME8AJ6C/Autism+spectrum+disorder+in+adults.png)
FAQs
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“Positive behavioural support is a multicomponent framework for (a) developing an understanding of the challenging behaviour displayed by an individual, based on an assessment of the social and physical environment and broader context within which it occurs; (b) with the inclusion of stakeholder perspectives and involvement; (c) using this understanding to develop, implement and evaluate the effectiveness of a personalised and enduring system of support; and (d) that enhances quality of life outcomes for the focal person and other stakeholders.”
1 Gore, N. J., McGill, P., Toogood, S., Allen, D., Hughes, J. C., Baker, P., ... and Denne, L. D. (2013). Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support, 3(2), 14-23
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“At its core, ABA is the practice of utilizing the psychological principles of learning theory to enact change on the behaviors seen commonly in individuals diagnosed with ASD (Lovaas et al., 1974). Ole Ivar Lovaas produced a method based on the principles of B. F. Skinner’s theory of operant conditioning in the 1970s to help treat children diagnosed with ASD (or “autism” at the time) with the goal of altering their behaviors to improve their social interactions (Lovaas et al., 1973; Skinner, 1953; Smith & Eikeseth, 2011).”
Gitimoghaddam M, Chichkine N, McArthur L, Sangha SS, Symington V. Applied Behavior Analysis in Children and Youth with Autism Spectrum Disorders: A Scoping Review. Perspect Behav Sci. 2022 May 18;45(3):521-557. doi: 10.1007/s40614-022-00338-x. PMID: 36249174; PMCID: PMC9458805.
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Behaviourism was founded on the belief that only externally observable behaviours count, and that thoughts and feelings (‘private events’ or ‘inner variables’) are not always relevant to how to control behaviour.
Cooper, J. O., Heron, T. E., and Heward, W. L. (3rd Ed. Global Ed. 2020). Applied Behavior Analysis. Pearson Education.
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Although BILD state that ‘PBS and ABA are not the same thing’ (2022). Gore et al. (2022) and MacDonald (2016) note that Positive Behaviour Support is founded on, and still underpinned by, the principles of Applied Behaviour Analysis. PBS has attempted to avoid the punishment procedures which are more common in ABA and has been more open to collaboration with a wider variety of professionals. Johnston et al. (2006:38) described PBS as ‘…a watered-down or less technical version of ABA, more marketable to service providers without ABA training as it requires less technical expertise, which is less robustly evaluated and involves less vigorous training.’ MacDonald also notes that ‘…when the implementation of PBS is described, it is very difficult to differentiate it from ABA.’
Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., and Mulick, J. A. (2006). Positive behavior support and applied behavior analysis. The Behavior Analyst, 29, 51-74.
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Applied Behaviour Analysis (ABA) and Positive Behaviour Support (PBS) are approaches that focus on modifying outward behaviours to conform to societal norms. These behaviourist-based approaches do not adequately consider the preferences, needs, or consent of Neurodivergent people. They often don’t seek 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. This suppression can cause intense distress, and trauma and negatively impact wellbeing. By focusing on supressing the behaviour of individuals ABS and PBS fails to address the systemic and societal barriers Neurodivergent individuals face.
The International Journal for PBS (Gore et al 2022) state that:
PBS … is not intended for persons identifying as neurodivergent who do not have a learning disability.
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Arguably, there is a stronger evidence base about the effectiveness of PBS for people with learning disabilities. However, it's concerning that in over 40 years of practice, there still isn't clarity on what people with learning disabilities think about this and how they experience PBS. There are also significant concerns about the quality of many research studies (Pukki et al). NDC believes that many of the concerns that apply to Autistic people are also relevant to people with a Learning Disability. Concerns include that the approach is not inherently human rights supporting, that there is huge variation in quality and design of delivery, and that this approach may be adding to harm, trauma, and distress.
Our collective goal should be to improve life experiences and well-being, not modify behaviours to fit normative expectations.
Pukki, H., Bettin, J., Grey Outlaw, A., Hennessy, J., Brook, K., Dekker, M., Doherty, M., Shaw, S. C. K., Bervoets, J., Rudolph, S., Corneloup, T., Derwent, K., Lee, O., Garcia Rojas, Y., Lawson, W., Vidal Gutierrez, M., Petek, K., Tsiakkirou, M., Suoninen, A., Minchin, J., Döhle, R., Lipinski, S., Natri, H., Reardon, E., Villarreal Estrada, G., Platon, O., Chown, N., Satsuki, A., Milton, D., Walker, N., Roldan, O., Herrán, B., Limón Cañedo, C., McCowan, S., Johnson, M., Turner, E. J., Lammers, J., & Yoon, W. (2022). Autistic perspectives on the future of clinical autism research. Autism in Adulthood, 4(1), 1-12. https://doi.org/10.1089/aut.2022.0017
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ABA and PBS are often presented as effective interventions, so it is crucial to understand the concerns raised by many Neurodivergent individuals, advocates, and researchers.
ABA, PBS, and other radical behaviourist approaches may seem helpful and like they ‘work’ but often prioritise compliance and behaviour modification over the holistic well-being and autonomy of Neurodivergent individuals and embed masking behaviours. There is not an evidence base to support their use, and application for Neurodivergent individuals is not best practice.
Many Neurodivergent adults report negative experiences with these methods, emphasising the need for alternatives that respect their diversity.
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Compassionate and neurodiversity-affirming alternatives to ABA and PBS prioritise the well-being, autonomy, and individuality of Neurodivergent people. They are informed by Neurodivergent voices, and culture and presume competence, taking a strengths-based approach and tailoring support to individuals' needs. These alternatives create a supportive and respectful environment which honours individual goals, milestones, needs, and strengths, instead of enforcing conformity.
Approaches which are relationship-based, person-centred, regulation-focused, and trauma-informed, and prioritise sensory-friendly and low-arousal environments, like the SPACE framework, NEST approach, and the National Autistic Taskforce's Key Principles of Quality Care for Autistic People, foster dignity, trust, and empowerment. By choosing compassionate and neurodiversity-affirming, respectful alternatives, professionals can support Neurodivergent individuals to authentically thrive while cultivating a sense of self-worth, acceptance and belonging.
Further reading from our blog
PDF Version
© Neurodiverse Connection 2025 All Right Reserved
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 learningdisabilities?
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 – whether for Neurodivergent people or people with learning disabilities.