Why PBS is Harmful for Autistic and Neurodivergent Young People

By Helen Edgar – Autistic Realms (May 2025)
Originally written for and shared by Neurodiverse Connection as part of their Against ABA and PBS Campaign 2025

As an Autistic adult, parent to neurodivergent children, and former SEND teacher, I’ve spent years navigating systems that claim to support inclusion while enforcing conformity. Among these, Positive Behaviour Support (PBS) is one of the most pervasive and harmful practices used with Autistic and neurodivergent children in UK schools and care settings and recommended on parenting courses. Often viewed as a gentler alternative to Applied Behaviour Analysis (ABA), PBS retains the same harmful foundations: compliance, control, and behavioural modification.

Despite its “positive” branding, PBS is not and cannot be neurodiversity-affirming. It is a behaviourist framework rooted in trying to make neurodivergent children fit into neuronormative expectations and values through external rewards and sanctions. PBS teaches and reinforces that a young person’s natural ways of being are wrong. Rather than being supportive, PBS often leads to masking, burnout, and trauma. 

The Behaviourist Roots of PBS

PBS emerged directly from ABA, a model built to change behaviour through external reinforcement, not to understand or affirm a person’s internal state and authentic identity. Though some see PBS as a more compassionate alternative, the difference is one of aesthetics: pretty packaging, cute-looking children’s games, and social stories all with the aim that “challenging behaviour” or different ways of being must be corrected and that observable compliance is the ultimate goal.

As Gore et al. (2022) state, “PBS is not intended for persons identifying as neurodivergent.” Yet, these approaches are widely applied to neurodivergent pupils without acknowledging the mismatch in values, experiences, and communication styles. PBS strategies such as token systems, reward charts, and certain social stories are often packaged in a sugar coating; teachers can be swept up into thinking that they are really helping young people. However, when you dig a bit deeper, the underlying message of PBS is that a child’s acceptance is dependent on behaving like a neurotypical person. PBS reinforces that Autistic people are not good enough as they are, and it can increase the feelings of shame that they experience.

Masking and Burnout

One of the most harmful consequences of PBS is the encouragement of masking. Masking is the act of suppressing natural needs and sensory signals to meet external expectations. PBS reinforces masking behaviour. Children praised for “good sitting” or “whole-body listening” may in fact, be frozen in anxiety, dissociating, or trying desperately to avoid punishment. When children perform compliance while suppressing their distress, the result is often long-term harm, and they will not be in any meaningful space to engage with learning.

PBS and Educational Practice

Reinforcing desirable behaviour and ways of communicating and socialising becomes especially dangerous when it ignores or overrides a child’s internal experience. Reflecting on my own past practice as a teacher, which was rooted in behaviourist approaches in my teacher training, I now recognise how common praise for quietness or eye contact may have reinforced survival strategies rather than supported authentic engagement.

I used PBS strategies myself before I knew better. I have had to unlearn a lot of my teacher training and relearn other ways of supporting Autistic people. PBS may appear to “work” on the surface and show results, but we need to consider the cost of this apparent progress.  Too often, compliance masks shutdown and doesn’t allow space for real learning and growth. What looks like progress may be performance that comes at the cost of a child’s well-being. As teachers, parents and professionals, we can only do the best we can with the knowledge we have at the time, but when we know better and know about the harm of PBS we need to start thinking of alternative ways and practices and better ways of connecting with children that honour their authentic ways of being and builds trusting relationships.

Despite its name, PBS is not trauma-informed and is not positive. Practices such as “planned ignoring,” holding back desired items until communication occurs in a prescribed manner (e.g., through PECs), and rewarding communication, sensory and social compliance to neuronormative standards and ideas fails to respect the reality of trauma and distress many neurodivergent children experience. 

Research has shown that behaviourist approaches are linked to long-term harm. Anderson (2023) and Kupferstein (2018) both document increased PTSD symptoms, anxiety, and suicidal ideation in Autistic individuals subjected to ABA-style interventions. What looks like gentle support may be really traumatising.

Compliance is Not Connection

One of the most harmful myths of PBS is the belief that reward systems build positive relationships. For neurodivergent children, relational trust isn’t built through praise or stickers, it’s built through attunement, empathy, and consent.

True connection happens when children feel seen, heard and respected, not managed and controlled. Conditional acceptance based on behaviour set up against neuronormative ideals teaches Autistic children that their worth is tied to performance. They learn to mistrust adults and suppress their authenticity. For many Autistic young people, especially PDAers or those aligned with monotropism, external rewards may feel irrelevant or even undermining.

As the Therapist Neurodiversity Collective points out, behaviourist models presume motivation comes from external validation. But many Autistic people are intrinsically motivated, led by interest (monotropic), led by their sensory needs and their ethical values. PBS fails to respect our inner worlds as Autistic people, focusing instead on observable outcomes and “compliance” rather than connection or understanding.

PBS Punishes Difference

At its core, PBS doesn’t just ignore neurodivergent ways of being; it actively invalidates a person’s Autistic identity. Behaviours that help Autistic people regulate, such as stimming, moving, communicating, working and playing in different ways, are often actively discouraged or punished within PBS fraemworks. I’ve seen sensory tools removed for being “misused”,  meltdowns labelled as defiance, and children being labelled ‘naughty’ when in overwhelm.

In these moments, distress is often misinterpreted as disruption and the child (or even the parent/carer) is often blamed and their autonomy is dismissed. This is especially harmful for those already vulnerable to biased interpretations, such as children with learning disabilities, those from minority backgrounds, and those who don’t communicate in expected neuronormative ways. PBS often reinforces ableism and systemic injustice. The Culture of Care Statement (2024) highlights that Black children are disproportionately targeted by restrictive behaviour systems, which often misread culturally valid communication as deviance. What is framed as neutral “support” often upholds systems of racism and ableism.

Consent and Autonomy Matter

Neuroaffirming practice needs to centre autonomy and consent. That means respecting a child’s “no,” listening to their body language and sensory needs and responding to their right to disengage when needed. It means supporting diverse communication methods and understanding that regulation can look very different for Autistic people and that co-regulation and interdependency are equally valid.

PBS undermines a young person’s autonomy and right to consent at every level. It teaches children that adults know better than they do, that their bodies can’t be trusted, and their instincts must be controlled at all times. When we teach children to ignore their own minds and bodies in order to gain approval, we are teaching them that they don’t matter and they can’t trust themselves.

What Counts as “Evidence”?

PBS is often described as “evidence-based,” but this claim needs a bit of a deeper dive. Much of the evidence around PBS and ABA relies on adult observers interpreting a child’s external behaviour and rarely includes Autistic voices. As NICE guidelines (NG11) caution, the evidence for ABA-style interventions is limited, and reliance on behavioural outcomes can be misleading.

Organisations and work from the Culture of Care and the Therapist Neurodiversity Collective argue that PBS research is outdated and misaligned with the neurodiversity paradigm. Evidence without lived experience is not reflective of the real inner experiences and needs of Autistic people. We need frameworks that centre the people that are being supported, not just those in charge of implementing interventions.

What’s the Alternative?

We need to build something better than PBS for our young people that doesn’t cause harm. The Autistic SPACE Framework (Doherty, McCowan & Shaw, 2023) offers a hopeful neuroaffirmative alternative. It focuses on:

• Sensory needs
  
  
  
• Predictability
  
  
  
• Acceptance
  
  
  
• Communication
  
  
  
• Empathy
  
  
  

We need to consider what a child needs to feel safe and connected, rather than looking at ways to change their behaviour. When we shift our thinking and change the environment instead of the person, we can create space for trust, safety, well-being and learning. 

Embracing Authentic Autistic Identity & Thriving

PBS is not a neutral tool, it is situated in a behaviourist framework that is based on compliance, not care. PBS teaches children to mask, mistrust their bodies and minds, and to only equate their value with performance. 

Autistic and neurodivergent children do not need fixing; they need environments that honour their differences. We need safe spaces where children are listened to, respected, and supported to discover their true identity and be their authentic Autistic selves.

We need to move away from PBS and instead foster spaces and communities rooted in consent, curiosity, and compassionate care. Our focus should not be on managing and controlling Autistic young people; we need to build trust and understanding. We need to create spaces where young people can flourish and feel safe, where their needs are met. By rejecting PBS and ABA we can create and build alternative supportive frameworks where  young people can feel proud of their true Autistic identity and can thrive as they grow up.

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References & Further Reading

• Anderson, L.K. (2023). Autistic experiences of applied behaviour analysis. Autism, 27(3), 737–750.
  
  
  
• Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistic adults as a result of ABA. Advances in Autism, 4(1), 19–29.
  
  
  
• Gore, N. et al. (2022). Positive Behavioural Support in the UK: A State of the Nation Report. Int. J. of Positive Behavioural Support, 12(1), 3–16.
  
  
  
• Doherty, M., McCowan, S., & Shaw, S.C.K. (2023). Autistic SPACE: A novel framework. British Journal of Hospital Medicine, 84(4).
  
  
  
• NICE (2015). Challenging behaviour and learning disabilities: prevention and interventions (NG11).
  
  
  
• Therapist Neurodiversity Collective. (2023). Why PBS Is Not Neurodiversity Affirming.
  
  
  
• Culture of Care (2024). PBS Position Statement.

• Add your signature to Autistic Realms and Stimpunks Anti-Behaviourism Resources

Sign Why Sheet

• Stimpunks Behaviourism – collated research and resources (2025) https://stimpunks.org/why/behaviorism/

• Stimpunks Alternatives to ABA  –  collated research and resources (2025)  https://stimpunks.org/why/alternatives-to-aba/

Learn more about the Culture of Care Statement from Neurodiverse Connection and support their campaign

Check out the new website:
Barriers to Education

Barriers to Education – A free, neuro-affirming resource created by the Spectrum Gaming Team, offering practical tools and frameworks to help schools and families understand and reduce barriers to attendance.

It’s built around the WARMTH Framework (Wellbeing, Affirming Practice, Relational Approach, Mutual Understanding, Timely Response, Holistic Support) and includes co-produced guidance on topics such as burnout and recovery, which I was honoured to support alongside many other volunteers.

Check out the website: barrierstoeducation.co.uk