PBS, PBIS, and Positive Reinforcement are forms ABA.
The Therapist Neurodiversity Collective genuinely believes that all humans have the right to be treated with dignity, empathy, and respect. Training humans through operant conditioning (rewards and punishments) is dehumanizing.
Applied Behavior Analysis(ABA) practices will always be based upon a foundation of compliance, coercion, and behaviorist principles.
It is impossible to practice ABA even gently or playfully, without attempting to control and manipulate a person’s behavior. The fundamental goal of ABA is compliance with the will of the person in the position of authority, which counters self-determination, undermines self-advocacy efforts, and infringes on human dignity and fundamental human rights.
Both are forms of ABA. Therapist Neurodiversity Collective believes that the use of ABA on non-consenting humans is a violation of human rights.
Question: What does eliminating PBIS or PBS look like in pediatric or school therapy practices?
Answer: If treats, small gifts, special activities, etc. are planned, all students or clients receive them, regardless of the therapist’s perception of the child’s on-task behavior, regardless of attendance, test scores, the number of books read, a number of drills completed, or the amount of work completed. The child or teen gets the treat because they are a human being and a part of that community.
Question: What does eliminating PBS look like in rehabilitation or skilled nursing settings?
Answer: The patient’s rights and their right to refuse are honored and respected. Patients are not rewarded with access or denied access to their personal belongings, activities (such as outings, group events, TV shows, special treats, etc.), food, drink, visitors, and attention as a way to control their behavior. The patient has the same civil liberties and personal rights, and the same access to activities, foods, drinks, treats, and personal belongings that they had prior to becoming a patient. Patients are treated with dignity because they are human beings.
It is primarily Alfie Kohn’s work that shapes the Therapist Neurodiversity Collective’s position on behavior modification through PBS, PBIS, and positive reinforcement, or as he eloquently states, “control by seduction”.
• Dehumanizing and infantilizing.
• Ignores internal realities.
• Undermines intrinsic motivation.
• It’s all about compliance.
• It creates dependence.
• It communicates conditional acceptance.
“Our basic strategy for raising children, teaching students, and managing workers can be summed up in six words: Do this and you’ll get that. We dangle goodies (from candy bars to sales commissions) in front of people in the same way that we train the family pet. Since its publication in 1993, this groundbreaking book has persuaded countless parents, teachers, and managers that attempts to manipulate people with incentives may seem to work in the short run, but they ultimately fail and even do lasting harm. Drawing from hundreds of studies, Kohn demonstrates that we actually do inferior work when we are enticed with money, grades, or other incentives—and are apt to lose interest in whatever we were bribed to do. Promising goodies to children for good behavior, meanwhile, can never produce anything more than temporary obedience. Even praise can become a verbal bribe that gets kids hooked on our approval. Rewards and punishments are two sides of the same coin—and the coin doesn’t buy much. What is needed, Kohn explains, is an alternative to both ways of controlling people. Hence, he offers practical strategies for parents, teachers, and managers to replace carrots and sticks. Seasoned with humor and familiar examples, Punished by Rewards presents an argument that is unsettling to hear but impossible to dismiss.”
The Risks of Rewards – Alfie Kohn
Punished by Rewards? – Alfie Kohn
Rewards Are Still Bad News (25 Years Later) – Alfie Kohn
Five Reasons to Stop Saying “Good Job!” – Alfie Kohn
Dr. Damian E M Milton
Applied Behavioural Analysis and the autistic community: time to listen
“Criticisms made of Applied Behavioural Analysis (ABA) and Positive Behavioural Support (PBS) and its implementation with autistic people.”
Milton, Damian (2020) Applied Behavioural Analysis and the autistic community: time to listen.
In: Are We Asking the Right Questions About Behaviour? Studio3 Web Conference, 21 Oct 2020, Online. (Unpublished) (KAR id:83599)
Dr. Ross Greene, Ph.D.
Collaborative & Proactive Solutions (CPS) is the model of care Dr. Greene originated and describes in his various books.
“The CPS model is based on the premise that challenging behavior occurs when the demands and expectations being placed on a kid exceed the kid’s capacity to respond adaptively…” “…the goal is to help them solve those problems, rather than trying to modify their behavior through application of rewards and punishments.”
While Therapist Neurodiversity Collective recommends several aspects of the Lives in the Balance/Collaborative & Proactive Solutions (CPS) approach, we are highly disappointed that Lives in the Balance recommends the ableist treatment framework of Social Thinking®, a therapy company that actively teaches autistic people to mask and camouflage.
- Mental exhaustion
- Chronic debilitating anxiety
- Confusion or loss of identity
- Suicidal ideation
- Suicide attempt
- Death by suicide
Social Thinking ® curriculum and materials are not neurodiversity-affirming.
“We posit that Positive Behavioral Interventions and Supports (PBIS) serves as a way to label, punish, and surveil students, which is antithetical to trauma-informed education.”
Kim, R. M., & Venet, A. S. (2023). Unsnarling PBIS and Trauma-Informed Education. Urban Education. https://doi.org/10.1177/00420859231175670
Does Positive Behaviour Support (PBS) reduce challenging behaviour in adults with intellectual disability?
Conclusions: “No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes. Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.”
Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I., Crabtree, J., . . . Crawford, M. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: Cluster randomised controlled trial. The British Journal of Psychiatry, 212(3), 161-168. doi:10.1192/bjp.2017.34
Definitions of PBS, PBIS, and Positive Reinforcement
Positive reinforcement is a form of Applied Behavioral Analysis (ABA) that uses motivation through rewards. It is considered the cornerstone of Applied Behavior Analysis (ABA), especially ‘new’ ABA, ‘naturalistic ABA,’ and ‘motivational-based play therapy.‘ Positive reinforcement is a form of “Operant Conditioning” which is behavior manipulation through external forces.
“Positive behavior support may best be described as an individualized, problem-solving process grounded in ABA principles.”
Hieneman M. Positive Behavior Support for Individuals with Behavior Challenges. Behav Anal Pract. 2015;8(1):101-108. Published 2015 Apr 23. doi:10.1007/s40617-015-0051-6
School-wide Positive Behavioral Interventions and Supports (PBIS) is an example of applied behavior analysis.
Horner RH, Sugai G. School-wide PBIS: An Example of Applied Behavior Analysis Implemented at a Scale of Social Importance. Behav Anal Pract. 2015;8(1):80-85. Published 2015 Feb 24. doi:10.1007/s40617-015-0045-4
“In response to this lived experience the Committee are aware how behavioural interventionist therapies such as PBS, ABA are medicalised and differ crucially from the principles underlying Speech and Language Therapy (SLT), and Occupational Therapy (OT). Behavioural interventionist therapies are ultimately founded on modifying disabled people’s behaviour to meet goals decided by others; often to conform more closely with neurotypical communication, behaviour and/or norms and therefore the Committee believe cannot uphold the UNCRPD principles of autonomy, dignity, right to identity and freedom from non-consensual or degrading treatment.”
– Joint Committee on Disability Matters. (2023, February). Aligning Disability Services with the United Nations Convention on the Rights of Persons with Disabilities.
(***Therapist Neurodiversity Collective is cited on page 60 of this publication.)
“Theoretically, the distinction between positive and negative reinforcement has proven difficult (some would say the distinction is untenable). When the distinction is made purely in operational terms, experiments reveal that positive reinforcement has aversive functions. On a practical level, positive reinforcement can lead to deleterious effects, and it is implicated in a range of personal and societal problems. These issues challenge us to identify other criteria for judging behavioral procedures.”
Note: The author of this paper is a behaviorist and has served as president of ABAI, SABA, SEAB, and SEABA. As he discusses the harms of using positive reinforcement on human beings in the paper, he then concludes that
“The forms of behavioral control we call “positive” and “negative” are inextricably linked. Thus, decisions about “good” and “bad” methods of control must be decided quite apart from the questions of whether the methods meet the technical specification of “positive reinforcement” or “aversive” control. We need to seek a higher standard, one that emphasizes outcomes more than procedures. Our chief concern should not be whether the contingencies involve the processes of positive reinforcement, negative reinforcement, or punishment. Instead, we should emphasize the ability of the contingencies to foster behavior in the long-term interest of the individual.”***
Perone M. Negative effects of positive reinforcement. Behav Anal. 2003;26(1):1-14. doi:10.1007/BF03392064
*** Therapist Neurodiversity Collective’s position is that emphasizing clinical outcomes at the expense of the emotional well-being of the human on the receiving end of the treatment is unethical and ableist.
On ‘Positive Behaviour’ Support – AMASE (Autistic Mutual Aid Society Edinburgh)
Autism, ABA and PBS: Some questions – Ann’s Autism Blog. Ann Memmott (2017)
Ask ABA PBS Controversy Autism Discussion UK – Facebook Group
Avoiding the “Good Job!” Habit
Therapist Neurodiversity Collective, Diane Cullinane, M.D.