Rethinking support for Neurodivergent people: why we need an alternative to current PBS plans
We’re joined by Kay Louise Aldred, NdC’s Development Lead, for the fourth blog of our latest campaign ‘Against PBS & ABA’.
Kay explores the genuine need to move beyond PBS and adopt Neurodivergent-affirming practices, such as those in our new interactive toolkit.
We have been told by practitioners that Positive Behaviour Support (PBS) plans can be implemented with good intent and in good faith, to improve quality of life and reduce distress. However, we have also been told of instances where PBS plans cause more harm than help. We know that PBS plans can vary dramatically in the quality of their design and implementation, remaining rooted in outdated assumptions and frameworks, and failing to be co-produced. We know PBS plans can fail entirely to be informed by or reflect the lived realities and experiences of Neurodivergent individuals.
It's time to look deeper and ask, who are these plans serving and who gets left behind?
Beyond behaviourism: we are more than what can be seen
At its core, PBS often adopts a behaviourist framework, focusing on what can be observed, measured and managed. But behaviour is communication – an externally visible expression of our invisible internal state. For Neurodivergent individuals, especially Autistic people, responses often arise from internal, sensory and nervous system processes that aren’t visible. When we ignore these embodied experiences, we misunderstand and potentially pathologise what are adaptive, meaningful responses.
Communication goes beyond words
Many PBS plans rely heavily on verbal communication and assume that language is everyone’s primary or preferred method of expression. But for individuals who communicate non-verbally, whether through Augmentative and Alternative Communication (AAC), body language or sensory cues, this approach can be deeply exclusionary. Without inclusive, multi-modal strategies, there is a real risk that their needs, consent and preferences go unheard or are misinterpreted.
Sensory processing matters
Sensory needs are not an optional extra to consider for Neurodivergent people: they are central to how we engage with the world. Yet most PBS plans overlook this entirely. When sensory differences are ignored, behaviours like stimming, meltdown, withdrawal or shutdown are misunderstood and misinterpreted as problems to be corrected, rather than protective, regulatory strategies.
The harm of a one-size-fits-all approach
We are aware of instances where fixed PBS plans are applied broadly, as a standardised, blanket approach for all, including Neurodivergent individuals who don’t have a learning disability. This can be harmful when Neurodivergent identity and internal experiences are not acknowledged. These individuals may be articulate or mask externally, yet their needs are often unseen and invalidated, leading to chronic stress, burnout and disconnection from self.
Language, identity and diagnosis matter
Many in the Autistic community prefer identity-first language, Autistic person, not person with Autism. This is about pride, not pathology. A lack of understanding or affirmation of this identity can lead to increased masking, diminished wellbeing and a fractured sense of self. Diagnosis should be a gateway to understanding, not erasure.
Regulation through a neuronormative lens
Too often, PBS strategies promote neuronormative ideas of regulation, encouraging smiling, laughter or gratitude as default states of ‘being okay’. While these may help some, they can inadvertently promote masking: teaching people to appear calm, even when they’re not. Regulation is not about pretending, it’s about truly supporting the nervous system and recognising that safety and calm come from within and are a byproduct of coregulation and safe connection with others and the environment, not performance.
Regulation is not the same as 'calming down’
Let’s be clear: regulation does not mean calming down. True regulation means supporting someone through the full cycle of their stress response in a titrated and resourced way, feeling, processing, and completing what the nervous system is trying to do. This isn’t a conscious choice or a matter of willpower; it’s deeply physiological and happens through a co-regulatory relationship. Behaviour is simply the visible expression of what the body is trying to process.
Emotions are not the enemy
A trauma-informed approach recognises that emotions are not ‘bad behaviours’ to suppress; they are messengers. They tell us what matters, what’soverwhelming and what needs attention, to be stopped or adjusted. Yet many PBS plans still treat emotions as problems to be fixed, rather than vital parts of being human. This pathologises authentic emotional responses and promotes emotional invalidation.
What’s missing: the internal world
Ultimately, many PBS frameworks focus almost exclusively on external behaviour. But this focus risks prioritising compliance over connection and surface-level change via masking over meaningful support. To truly support Neurodivergent individuals, we must engage with their internal experience: their sensory world, emotional landscape and embodied needs, not just what they do or look like externally, but how they feel and why.
The way forward
Supporting Neurodivergent people requires more than managing behaviour: it calls for understanding, respect and deep listening. Because behaviour is communication. When the ‘care’ and ‘support’ of a PBS plan comes at the cost of being truly seen and understood, then the PBS plan does not serve the person being subjected to it. Instead, the plan is serving those around that person. By deprioritising the needs of the person being subjected to the plan, we are demonstrably implying that their needs, rights and humanity are considered less-than. And we know that the impact of encouraging people to deny their needs, their identity and their sense of self can be far-reaching and deeply damaging.
We need alternatives to current PBS models that are grounded in Neurodivergent-affirming, trauma-informed, sensory-aware principles and reflective, relational approaches. We need support plans that honour identity, empower communication in all its forms and prioritise wellbeing over performance.
References
Doherty, M., McCowan, S., & Shaw, S. C. K. (2023). Autistic SPACE: A novel framework for meeting the needs of autistic people in healthcare settings. British Journal of Hospital Medicine, 84(4). https://doi.org/10.12968/hmed.2023.0006
What can you do?
Check out our interactive toolkit!
We have developed an alternative: a free interactive toolkit: ‘A practical approach to neurodiversity-affirming care’.
This toolkit contains:
Tool 1: Foundational principles, practical guidelines and reflection exercises
Tool 2: Discussion prompts, planning tools, strategies and action steps
Tool 3: Care plan template
Tool 4: Safety plan template
Tool 5: Combined care and safety plan summary template
