Summary
Positive Behaviour Support is a framework for understanding and responding to behaviours that services find challenging, widely used in UK care settings. It is presented as a āpositiveā alternative to aversive behaviour management, emphasising functional assessment (understanding why behaviour occurs) and proactive environmental support.
PBS recognises āsensory functionā as one behaviour category: people engage in repetitive movement, vocalisation, or other actions because sensory input is reinforcing. In principle, this should lead to sensory support. In practice, PBS has attracted sustained criticism from the neurodiversity and disability rights movements for how it handles sensory behaviour and for what it is underneath the āpositiveā branding.
What the evidence shows
How PBS addresses sensory needs
PBS uses functional behaviour assessment (FBA) to determine behaviour function. When a behaviour is assessed as sensory (rocking for vestibular input, hand-flapping for proprioceptive stimulation), PBS plans typically propose either providing alternative sensory input through āmore appropriateā means or modifying the environment to reduce the need for the behaviour.
The critiques
Multiple disability rights organisations and autistic self-advocates have raised serious concerns. AMASE has documented how PBS, as commonly implemented, encourages maskingāsuppressing natural sensory signals and communication to meet external expectations. If a PBS planās goal is reducing stimming frequency, it is functionally indistinguishable from the ABA approaches it claims to have moved beyond.
A Care Quality Commission review found PBS plans frequently omitted diagnosis information and showed inadequate consideration of sensory needs. Sensory assessment was not systematically included.
The ABC (Antecedent-Behaviour-Consequence) framework oversimplifies the relationship between sensory processing and behaviour. It does not account for cumulative sensory load, fluctuating arousal states, or neurobiological mechanisms of sensory regulation. Sensory-seeking behaviours are reframed as āproblem behavioursā to be managed rather than legitimate needs.
The fundamental critique: PBS is ultimately a framework for modifying disabled peopleās behaviour to meet goals decided by others (professionals, carers, service managers), rarely by the person whose behaviour is being analysed. This framework cannot uphold principles of autonomy, dignity, and freedom from degrading treatment when its foundational purpose is to change how someone behaves.
In the UK, PBS is promoted as a gentler evolution of ABA. Research shows the underlying philosophyābehaviour modification through environmental manipulationāis the same. The language changed; the power dynamic did not.
Open questions
Can PBS genuinely centre the personās sensory needs rather than the serviceās need for manageable behaviour? Some practitioners argue for āneurodiversity-affirming PBSā that treats sensory behaviours as valid communication and focuses environmental modification on the setting rather than the person.
The fundamental question: is there a version of functional behaviour assessment that serves the person rather than the institution? Functional analysis as a toolāsystematically observing behaviour and its contextāis not inherently problematic. The problem arises when the analysis purpose is reducing behaviour the person finds useful, for the convenience of those around them.
Implications for practice
The neurodiversity-affirming position: sensory behaviours are communication about the personās sensory state. The appropriate response is listening, not modification.
If a PBS plan targets sensory behaviours for reduction, ask whose goal this is. Does the person want to change it, or does the service find it inconvenient?
Environmental modification should always come first. If someone rocks because the environment is sensorily overwhelming, the environment needs changing.
Where PBS is mandated (in many funded care settings), advocate for plans that include comprehensive sensory assessment, centre the personās preferences, and distinguish clearly between behaviours the person finds distressing and behaviours others find challenging.
Key sources
- AMASE (2022), PBS Concerns document
- Autistic Realms, āWhy PBS is Harmful for Autistic and Neurodivergent Young Peopleā
- Care Quality Commission review of PBS plan quality
- PMC (2024), discussion of PBS and ABA relationship