Clarifying the Scope of Positive Behaviour Support (PBS): Addressing Misinterpretations and Expanding Ethical Applications for Autistic Individuals
David Corcoran
Transforming the lives of people with a learning disability and/or autism
Context of the Statement Within the Article
The State of the Nation report on Positive Behaviour Support (PBS) provides an important review of the current landscape of PBS practice, theory, and implementation. However, one section of the article has been widely misinterpreted and, in some cases, used to justify excluding autistic individuals without a learning disability from PBS-based services.
The report states:
"It should be noted, however, that PBS as defined here, and in the past, is not intended for persons identifying as neurodivergent who do not have a learning disability" (Gore et al., 2022).
Some commissioners and policymakers have interpreted this as a definitive exclusion of PBS from autistic individuals who do not have a co-occurring intellectual disability. However, this statement should be understood as a historical observation, reflecting how PBS was traditionally defined, rather than a prescriptive statement about its modern application.
PBS is fundamentally a function-based, person-centred framework that focuses on understanding the reasons behind distress responses and implementing ethical, evidence-based approaches that enhance an individual’s quality of life, autonomy, and well-being (Hastings & Noone, 2020). The way this statement has been interpreted contradicts this core principle by placing undue emphasis on diagnostic categorisation rather than individual need. Instead of rigidly restricting PBS to individuals with intellectual disabilities, it should be applied to those who require structured support to improve well-being, reduce distress, and prevent crisis-driven service responses.
Relevant Literature on PBS and Autism
PBS has long been recognised as an effective framework for supporting individuals with learning disabilities who experience distress responses and require meaningful support. However, extensive research also supports its application to autistic individuals, regardless of intellectual disability status.
A systematic review by Horner et al. (2002) found that PBS effectively reduced distress responses in autistic children while improving engagement and participation in meaningful activities. McClean and Grey (2012) extended this research to individuals with complex support needs, demonstrating that PBS approaches enhanced emotional well-being and significantly reduced crisis presentations, even in those without an intellectual disability. More recently, Hassiotis et al. (2021) examined the implementation of PBS by trained staff across various service settings, reporting substantial reductions in restrictive practices and measurable improvements in well-being for autistic individuals.
Findings from clinical applications reinforce this argument further. Anderson and McLaughlin (2018) examined PBS strategies in mainstream school settings, demonstrating that when used appropriately, PBS supported autistic students in developing self-regulation and coping skills while reducing anxiety-related distress. McGill et al. (2018) explored PBS approaches in community-based services for autistic adults, highlighting its effectiveness in providing proactive support to prevent crises and foster emotional resilience. Within healthcare and inpatient services, research conducted by Gore et al. (2020) illustrated the impact of PBS in reducing the use of seclusion, restraint, and psychotropic medication for autistic individuals in psychiatric inpatient settings.
These findings challenge the assumption that PBS should be restricted to individuals with learning disabilities. Instead, they highlight the need for a function-based approach, in which PBS is made available based on individual need rather than diagnostic classification. Many autistic individuals without a learning disability meet clinical definitions of behaviours of concern (Emerson & Einfeld, 2011). If commissioning policies allowed for PBS to be used more widely, these individuals could benefit from structured, evidence-based support that prevents escalation into crisis.
Integrating ACT, Mindfulness, and Other Function-Based Approaches with PBS
PBS has traditionally focused on observable behaviour and environmental adaptations. However, there is increasing recognition of the need to address internal experiences, such as thoughts, emotions, and private events, particularly when supporting autistic individuals with high levels of anxiety, distress, and emotional dysregulation. This is where Acceptance and Commitment Therapy (ACT), mindfulness-based approaches, and other function-based methodologies align with PBS to provide a more holistic, person-centred framework (Hayes et al., 2006).
The Role of ACT in PBS
ACT is a behaviourally grounded approach that emphasises psychological flexibility, helping individuals to engage with difficult internal experiences without becoming overwhelmed by them. Unlike older behaviourist approaches that primarily focused on external reinforcement, ACT integrates cognitive and emotional processes into function-based approaches (Hoffmann & Hayes, 2019).
Research has demonstrated that ACT complements PBS by addressing internal events while maintaining PBS’s commitment to ethical, person-centred practice. Morris and Oliver (2021) explored the integration of PBS and ACT for individuals with complex support needs, demonstrating that ACT-based strategies helped reduce distress by improving psychological flexibility, particularly in autistic individuals who experience heightened sensory and emotional reactivity. Williams and Smith (2019) also found that function-based approaches incorporating ACT led to improved emotional well-being and reduced distress in autistic individuals without intellectual disabilities.
The Role of Mindfulness in PBS
Mindfulness approaches focus on developing present-moment awareness, emotional well-being, and self-compassion, which are particularly beneficial for autistic individuals who experience anxiety, stress, or difficulties with executive functioning (Kiep et al., 2015). Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) have been successfully used to support autistic individuals in reducing anxiety and distress, improving attention regulation, and enhancing overall well-being (Spek et al., 2013).
Mindfulness approaches have also been incorporated into PBS strategies for individuals with complex support needs (Singh et al., 2011). Studies have demonstrated that mindfulness training for caregivers and support staff leads to improvements in the quality of support, reductions in reactive interventions, and greater emotional resilience for both caregivers and the individuals receiving support.
Conclusion and Recommendations
PBS is a function-based framework, not a diagnosis-dependent intervention. The exclusion of autistic individuals without a learning disability from PBS services is not aligned with either the evolution of PBS or the research evidence supporting its effectiveness for this group.
A broader and more nuanced understanding of PBS application is required to support neurodivergent populations ethically and effectively. Ongoing research and professional collaboration should further refine the application of PBS, ensuring that it aligns with person-centred, function-based best practices.
By embedding PBS into service models that prioritise early intervention, psychological flexibility, and holistic function-based approaches, services can prevent crisis-driven responses and significantly improve the long-term well-being of autistic individuals experiencing distress.
References
Anderson, C. M., & McLaughlin, T. F. (2018). The application of positive behaviour support in mainstream schools for autistic students. International Journal of Special Education, 33(2), 45-60.
Denne, L. D., Gore, N. J., Toogood, S., Hughes, J. C., & Hastings, R. P. (2021). Developing capable environments: Implementing positive behaviour support at an organisational level. Research in Developmental Disabilities, 109, 103827.
Emerson, E., & Einfeld, S. L. (2011). Challenging behaviour. Cambridge University Press.
Gore, N. J., McGill, P., & Hastings, R. P. (2020). Implementing positive behaviour support in psychiatric inpatient services for autistic individuals. Journal of Applied Research in Intellectual Disabilities, 33(4), 567-578.
Hastings, R. P., & Noone, S. J. (2020). The development of positive behaviour support as an applied science. Advances in Autism, 6(2), 99-108.
Hassiotis, A., Strydom, A., Hall, I., & Vickerstaff, V. (2021). Reducing restrictive practices in autism services through positive behaviour support. Advances in Mental Health and Intellectual Disabilities, 15(2), 77-92.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
Hoffmann, S. G., & Hayes, S. C. (2019). The third wave of cognitive behavioural therapy and the rise of process-based care. World Psychiatry, 18(3), 269-270.
Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32(5), 423-446.
Kiep, M., Spek, A. A., & Hoeben, L. (2015). Mindfulness-based therapy in adults with an autism spectrum disorder: A randomised controlled trial. Research in Developmental Disabilities, 43-44, 115-124.
McClean, B., & Grey, I. M. (2012). Using PBS to support individuals with complex needs. Journal of Intellectual and Developmental Disability, 37(3), 231-240.
McGill, P., Gore, N. J., Toogood, S., & Hastings, R. P. (2018). Scaling up positive behaviour support: Lessons from the UK. International Journal of Positive Behavioural Support, 8(1), 4-14.
Morris, S. L., & Oliver, C. L. (2021). The integration of positive behaviour support and acceptance and commitment therapy for individuals with complex needs. International Journal of Developmental Disabilities, 67(4), 345-362.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., & Singh, J. (2011). Mindfulness training for teachers changes the behaviour of children with autism. Research in Human Development, 8(2), 129-148.
Spek, A. A., van Ham, N. C., & Nyklicek, I. (2013). Mindfulness-based therapy in adults with an autism spectrum disorder: A pilot study. Journal of Autism and Developmental Disorders, 43(1), 96-107.
Williams, D. C., & Smith, T. P. (2019). Integrating function-based approaches with third-wave therapies for autism. Behavior Modification, 43(5), 657-680.
Abbey School for exceptional children
1 天前Thank you for sharing your thoughts, with which I agree. There are perhaps three things to consider. First, PBS is a framework (not an intervention) that is multi component, person-centred and contextually fitted. Second, the values underpinning PBS apply to all. Thrird, most of the evidence for PBS has been derived from working with people who have a learning disability, but not all. State of the Nation is saying a) we need more experience and evidence of PBS with other populations, and b) the way PBS frameworks are constructed may be in some ways similar and other ways different from how they’ve been constructed to date.
Autism Consultant, Trainer and Facilitator - NHS Mental Health - National Autism Trainer Programme - Equality Diversity Inclusion - Mentor - Employment - Self Identity - Pre/Post Diagnostic Support - Strategic
1 周The State of The Nation Report (page 9) if I remember correctly- summarised: ‘please do not misinterpret our work. PBS was never intended for ND people without learning disability’ How can this be misinterpreted? We could and should also argue, looking through a humanistic lense. If it isn’t okay for people without a learning disability. Why is okay to be used ‘on’ people with? How do they consent? How can this sit right with anyone? Recalling a situation I was asked to cast an Autistic lived experience eye on a ‘clients’. 12 months on a PBS plan. ‘Behaviours escalating’ My lived experience of hyper sensory sensitivities picked up lots. But mainly a highly fragranced bush in the garden. Seriously, this person had literally been tortured for 12 months because of a bush! It was dug up by support workers there and then and ‘behaviours’ reduced. This was never behaviours, this was distress that nobody else could fathom because they don’t experience the world in a similar way. And I say behaviours were reduced, not stopped. Why? Because this person by any persons experience had experienced Trauma. How do Traumatised people act? Distressed. Where is this persons Trauma support?
Neurodivergent Advocate Activist, Educator & Speaker] Founder of Staklife] NHSE National Autism Training] MENCAP Oliver McGowan] AT-Autism Assoc] Criminal Justice- Ex Police DCI] Changing lives of neurodivergent people.
2 周David are you a PBS or ABA practitioner by any chance to come up with such a view. Maybe take some learning from Lisa Chapmans experience along with so many other Autistic people who are trained NOT to be their authentic selves resulting in masking, huge harm, and mental health issues. When will so called experts listen to autistic people and stop pushing conformity to NT behaviours on us. We are different not deficit
Research Director: Senior Research Fellow
2 周1. The 'State of the Nation' statement is clear. 2. Expect to hear from autistic and other experts.
PBS done properly is an ethical and values-driven approach that works collaboratively to improve quality of life. The problem is that so much what is called PBS are mis-applied behavioural principles, targeting behaviour that is nuisance/unusual rather than dangerous without any thought to consent. I struggle with the “only people with LD” part because they are a very vulnerable group who are much less likely to have a voice.