Huw Price, PBSuk Associate Director

“The autistic community dislike PBS.” This quote was shared with me recently by a colleague, from a presentation delivered by a professional working in the field of intellectual and developmental disabilities. It may seem unsurprising to many of you; it is not a particularly uncommon statement to hear. However, is it not something that should be considered in more depth? Should there not be a call for more nuance? My first thoughts regarding this, were:

• ‘What autistic community?’
• ‘Where does this community start or end?’
• ‘Who decides who is, and isn’t, allowed to belong to such a community?’

Brugha et al. (2016) estimated that in England, 1 in 58 people are autistic (although considering estimates in other areas of the world, this may be unduly conservative). Doing some rough calculations means that this equates to around 1 million autistic people in England. Taking the above statement literally (which I tend to do), this would mean that 1 million people collectively share exactly the same view, irrespective of age, gender identity, ethnicity, cultural background, life experience etc. Of course, when it is presented in these terms the idea seems slightly ridiculous. However, phrases such as “the autistic community dislikes PBS” are relatively common – why are they accepted without further consideration?

I was recently fortunate enough to collaborate on a project with a group of neurodivergent practitioners, several of whom are, like me, autistic. We of course occupy our own little echo-chamber of neurodivergent practitioners (and I’m not trying to argue that our views are representative of autistic people’s views more broadly). However, similar topics to that which I am describing here arose, and whereas the project in question required formal consideration of these issues, it made me reflect on my anecdotal experiences.

Since my daughter was diagnosed as autistic, and after I followed in her footsteps and sought a diagnosis myself, I have gradually become more open about being neurodivergent. Seemingly, the effect of this is that others reciprocate and are open in return. I have found that it is not uncommon for me to meet other autistic people outside of a work context. Something that strikes me about these encounters, is that when I explain my work or describe myself as either a PBS Practitioner or a Behaviour Analyst, I am met, not with revulsion or contempt, but usually with blank faces.

My point is that the binary ‘for vs against’ discourse regarding PBS doesn’t seem to be a realistic representation of how the autistic people I meet ‘in the wild’ view PBS. I suspect that social media has a lot to answer for, in only representing the extremes of an argument. There are of course autistic people who do dislike PBS and ABA, and they are entitled to do so, and to voice their views. However, there are also those who have a positive view of PBS. Importantly, however, there are many autistic people who have no idea what PBS is, for whom it is simply irrelevant, or those who occupy one of a myriad of other possible positions.

Binary discourses

More broadly, the binary discourse regarding PBS can be thought of as seeing the world in only black and white (i.e., it is either completely good, or completely bad). Here, I am advocating for more consideration of the ‘grey areas’ of life. Please don’t think I am attempting to silence the critics – taking the view that anything delivered under the banner of PBS is inherently good, is an equally flawed position. For example, regulators such as CQC having the expectation that services supporting people with intellectual and / or developmental disabilities who can display behaviours of concern should all implement PBS, could be argued as being too blunt an instrument, and inadvertently encouraging tokenism.

There is increasing recognition in the UK, that often, that which is delivered in the name of PBS, is simply a repackaging of what organisations have always done (Care Quality Commission, 2020; Gore et al., 2022; Price et al., 2026) and there are various examples of mechanistic and dehumanising approaches which purport to be PBS (Positive and Active Behaviour Support Scotland and Challenging Behaviour Foundation, 2020; Quinn, 2025), despite a complete lack of a genuinely person-centred approach, or any attempt to consider the person’s own experience.

Poor practice being delivered under the banner of PBS does nothing to dispel commonly held misconceptions such as ‘PBS or ABA do not consider thoughts or feelings, or autonomic responses’ (i.e., reflexive behaviours that are not maintained by consequences), that they are normative in their aims, or that they rely on punitive or aversive approaches. Equally, dismissing such accounts entirely, risks falling into the ‘black and white’ view again.

Whether or not we agree or disagree that these things are “PBS”, they are openly being called PBS and if poor support is called “PBS” frequently enough, arguably that is what it has come to mean. I have argued before that the ‘marker in the sand’ described originally in the 2013 special edition of the International Journal of Positive Behaviour Support is needed now more than ever.

And now, time for something completely different

Recently, there has also been discussion of whether PBS training can be delivered alongside training regarding physical intervention. My main thought regarding this is, doesn’t this conversation miss the point entirely? There is research which clearly indicates that training in PBS alone, isn’t sufficient to change practice (Hassiotis et al., 2018).

As such, I suspect it doesn’t make the blindest bit of difference whether physical intervention training and PBS training are taught together, or separately. What I would question is, why it is that PBS is still being sold as a ‘training package’ at all? Long before the Hassiotis et al. (2018) study was conducted, it was well-established that implementing PBS involves far more than training for frontline staff (Allen et al., 2012; Allen et al., 2013).

Conflation of PBS training with physical intervention training, I would agree, has affected how PBS is viewed by some critics. It is particularly concerning that training regarding restrictive practices is often packaged as ‘PBS’, when those delivering the training do not have the knowledge or expertise to deliver this – a quick Google search of “PBS training” will yield some examples. One that I glanced at explained that the training provider in question had developed their own ‘simplified’ version of PBS (presumably as they felt that implementing PBS properly was too complicated…?)

Should PBS not be complicated? Is human experience and behaviour not complicated? If it is complicated, should that not mean that we educate ourselves, advocate for further training opportunities for staff teams, and aim to embed expertise and practice leadership alongside training, rather than developing a ‘simplified’ version…?

Existing in the ‘grey’

Back to the ‘autistic community’ disliking PBS. I’ve recently been working on some of the e-learning modules for the PBS Matters Level 6 Diploma, and it’s been a great opportunity to look at related issues in detail. Exploring some of the history of Applied Behaviour Analysis and ensuring that historic harmful practices are openly discussed within the content felt like an important area. Equally, looking in more detail at some of the criticisms of both ABA and PBS, and highlighting where these criticisms have validity, is something that I feel should be embedded within training for future practitioners.

Morris and Peterson (2022) provide an interesting article discussing such issues but also highlight the importance of exploring the broader social context when considering why aversive and punitive approaches were used by some early Behaviour Analysts. This may be an uncomfortable area for those of us who are practising behavioural science (the ‘grey’ often can be), but it is also an important one to confront, particularly if we are to try to understand why some autistic people are highly critical, and deeply mistrustful, of PBS.

What I do think is useful and constructive about the ‘grey area’, is that it allows a discourse whereby perspectives can be shared, considered, and importantly absorbed / adopted. Discourses which position themselves as “Against” either PBS or ABA are unlikely to be constructive in this respect, as they are unlikely to genuinely reach those who are practising, or to allow for nuance (i.e., some practices may be effective / socially valid / ‘good’, but some may not…)

I was lucky enough to recently stumble across an article by D’Agostino et al. (2026), which looked at the views of autistic adults, and parents of autistic children, of Early Intensive Behavioural Intervention in the USA. It struck me as interesting that the autistic adults didn’t deny that ABA is effective in producing outcomes such as skill acquisition, or that some form of early intervention may be needed for autistic children. However, they highlighted what they would want to see from any support provided, is for it to be kind, respectful, and promote the child’s autonomy (is this too much to ask for?)

This is of course an over-simplification, and I’d really recommend reading the full article. There are accounts of harm / trauma experienced as a result of receiving ABA from some of the participants, which are important to read, respect and reflect upon. The point that I am trying to make, is that entering the ‘grey area’ (i.e., there may have been some benefit to historic applications of ABA, but there may also have been significant harms to some of those who received it) allows for greater reflection, and hopefully for practice to change, to become more neurodiversity-affirming, and to centre the views of those who receive services.

Huw Price

PBSuk Associate Director

June 2026

References

Allen, D., Kaye, N., Horwood, S., Gray, D. & Mines, S. (2012). The impact of a whole organisation approach to positive behavioural support on the use of physical interventions. International Journal of Positive Behavioural Support, 2(1), 26–30.

Allen, D., McGill, P., Hastings, R. P., Toogood, S., Baker, P., … & Hughes, C. J. (2013). Implementing Positive Behavioural Support: Changing Social and Organisational Contexts. International Journal of Positive Behavioural Support, 3(2), 32–41.

Brugha, T. S., Spiers, N., Bankart, J., Cooper, S. A., McManus, S., Scott, F. J., Smith, J. & Tyrer, F. (2016). Epidemiology of autism in adults across age groups and ability levels. British Journal of Psychiatry, 209(6), 498–503. doi: 10.1192/bjp.bp.115.174649.

Care Quality Commission. (2020). Out of sight – who cares?: Restraint, segregation and seclusion review. Available at: https://www.cqc.org.uk/publications/themed-work/rssreview

Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I., Crabtree, J., … & Crawford, M. (2018). Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT. Health Technology Assessment, 22(15), 1–110. https://doi.org/10.3310/hta22150

Morris, C. & Peterson, S. M. (2022). Teaching the History of Applied Behavior Analysis. Perspectives on Behavior Science, 45(4), 757–774. https://doi.org/10.1007/s40614-022-00354-x

Positive and Active Behaviour Support Scotland and Challenging Behaviour Foundation (2020). Reducing Restrictive Intervention for Children and Young People. Available at: https://www.challengingbehaviour.org.uk/wp-content/uploads/2019/01/rireportfinal.pdf

Price, H., Bishop, K., Cooper, A., Scott-Harman, S., Lyon, K., Amaranath, S., Middleton, E., Ridley, J., Severs, P., & Corbett, S. (2026). A practitioners’ definition of Positive Behaviour Support. Tizard Learning Disability Review, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/TLDR-09-2025-0037

Quinn, A. (2025). Relationships of concern: The perils of the progress paradox in Positive Behavioural Support. International Journal of Positive Behavioural Support, 15(1), 35–44.