Positive Behaviour Support (PBS) is often framed as a progressive, person-centred approach to supporting individuals with disabilities, particularly Autistic people. Since the transition away from Applied Behaviour Analysis (ABA), PBS has been positioned as the preferred model under the National Disability Insurance Scheme (NDIS), with explicit funding pathways available to participants. However, the reality of PBS in practice raises significant ethical concerns, particularly regarding its foundations in behaviourism and its implications for Neurodivergent individuals’ autonomy and well-being.
PBS and Its Behaviourist Roots
Despite common misconceptions, PBS is not independent of ABA. The NDIS PBS Capability Framework (p. 5) explicitly references "applied behaviour analysis," confirming that PBS is deeply rooted in behaviourist principles. Behaviourism, at its core, is about modifying observable actions through reinforcement strategies, rewarding desired behaviours and ignoring or discouraging those deemed undesirable. While this may seem harmless on the surface, a deeper examination reveals troubling implications, particularly for Autistic individuals and others whose natural ways of communicating, interacting, and self-regulating are often classified as "problematic" within these frameworks.
The Ethics of Compliance-Based Models
A major criticism of PBS is its emphasis on compliance. Behaviourist strategies, including PBS, often teach individuals to suppress natural behaviours in favour of those that align with neurotypical/ neuronormative expectations. This can manifest in ways that seem beneficial in the short term, such as using Picture Exchange Communication (PECs) or reinforcing social behaviours, but at what long-term cost?
By prioritising compliance over autonomy, PBS sends a damaging message: that Neurodivergent people must change to fit into a neurotypical world. This can have profound consequences for mental health and self-identity. Individuals subjected to these interventions may internalise the belief that their authentic selves are unacceptable, leading to increased anxiety, depression, and trauma.
PBS Is Not for Everyone
PBS is often justified as a necessary intervention for individuals with learning disabilities who exhibit behaviours of concern. However, it is frequently applied to Neurodivergent individuals, such as Autistic people without a learning disability, despite a lack of evidence that it is appropriate or beneficial for this group. Neurodivergent individuals without intellectual disabilities often have (or can develop) the capacity to self-advocate, express their needs, and develop adaptive strategies that do not rely on external behavioural modification. Applying PBS to this population risks pathologizing natural Neurodivergent traits and enforcing compliance at the expense of autonomy and well-being.
For many Neurodivergent individuals, especially those who do not have a learning disability, the problem is not their behaviour, it is societal barriers, lack of accommodations, and misunderstanding of their needs. A Neurodiversity-affirming approach, rather than PBS, is more appropriate in these cases, as it respects individual agency and fosters true inclusion rather than compliance with neurotypical norms.
The Reality of PBS in Practice
PBS is widely implemented across Australian schools, residential care settings, and therapy/ support programs. Yet, many of its common strategies raise ethical concerns:
Planned ignoring: This approach, where distress or non-compliant behaviour is ignored until the "desired" behaviour is displayed, can be deeply harmful. It teaches individuals that expressing distress will not result in support, reinforcing feelings of isolation and learned helplessness.
Tokenism and rewards: Often, PBS uses rewards to reinforce compliant behaviours. However, in many cases, these "rewards" are actually personal belongings or essential comforts that have been taken away or withheld and must be "earned" back. This dynamic mirrors coercive control rather than genuine support.
Building trust only to enforce compliance: PBS practitioners often spend time establishing rapport with individuals before implementing compliance-driven interventions. This process, gaining a person’s trust and then using it to shape their behaviour, raises serious ethical concerns and, in some cases, may resemble grooming dynamics.
Capitalist structures and reliance economies: PBS is deeply intertwined within the NDIS and government funding schemes. Many providers and schools are in a cycle of reliance on these, instead of standing up and stating what is obvious to those that have experienced PBS's, which is that there are more natural and affirming ways to support our children, families, and communities.
The Call for Neurodiversity-Affirming Approaches
Autistic advocates, self-advocacy groups, and disability rights organisations, including GRANN, have been vocal in their opposition to PBS and other behaviourist models. The core argument is simple: support should empower individuals, not train them to conform.
So if not PBS, then what? The answer lies in approaches rooted in neuro-affirming support:
Radical acceptance: Recognising and honouring Neurodivergent ways of being rather than trying to "fix" or "normalise" them.
Autonomy and self-determination: Supporting individuals to be independent, in making their own choices, setting their own boundaries, and learning self-advocacy skills.
Sensory and communication support: Instead of forcing eye contact or scripted social interactions, embracing alternative communication methods and sensory accommodations that align with an individual's needs.
Connection, not control: Building relationships based on mutual respect, understanding, and authentic connection rather than compliance and behavioural reinforcement.
While PBS is framed as a progressive alternative to ABA (even though is is still often performed or overseen by behaviour analysts), its underlying principles remain deeply entrenched in behaviourism, prioritising compliance over autonomy. The ethical concerns surrounding its implementation, especially in vulnerable populations such as Autistic children, demand urgent attention. True support must move beyond modifying behaviour to fit societal norms and instead focus on fostering environments where Neurodivergent individuals can thrive on their own terms.
The question we must ask is this: Are we supporting individuals, or are we controlling them? If support comes at the cost of autonomy, dignity, or mental health and wellbeing, then it is not support at all - it is coercion. And that is not something we should accept. GRANN won't!
In solidarity