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N
Mixed Evidence

Behavioural Approaches

Understanding behaviour-based interventions - what they are, what to look for, and important ethical considerations parents should know.

Behaviour is communication

All behaviour serves a function. When a child behaves in ways we find challenging, they're usually communicating something they can't express otherwise.

Escape/Avoidance

Why: Task is too hard, too boring, or overwhelming. Sensory overload. Social demands exceeding capacity.

Looks like: Running away, refusing, meltdowns when demands placed.

Attention/Connection

Why: Need for interaction. Feeling disconnected. Want to share something.

Looks like: Interrupting, calling out, physical contact-seeking.

Access to tangible

Why: Wanting something specific. Hunger, thirst, need for item.

Looks like: Grabbing, tantrums for specific items, difficulty waiting.

Sensory/Internal

Why: Sensory need. Physical discomfort. Regulatory need.

Looks like: Stimming, fidgeting, self-injurious behaviour, seeking/avoiding sensory input.

Behavioural approaches

Positive Behaviour Support (PBS)
A framework focused on understanding behaviour function and improving quality of life.

Key principles:

  • Behaviour has a function - understand it first
  • Focus on quality of life, not just compliance
  • Change the environment, not just the person
  • Teach replacement skills
  • Use positive strategies, not punishment
  • Person-centred: individual preferences matter
Strong evidence base. Recommended in NICE guidelines.

PBS should be about improving life quality, not just reducing "challenging" behaviour.

Applied Behaviour Analysis (ABA)
A science of behaviour using principles of learning to change behaviour.

Key principles:

  • Based on learning theory and reinforcement
  • Uses data collection and systematic intervention
  • Wide range of practices under this umbrella
  • Quality varies significantly by practitioner
Some research support for specific skills. Contested for autism - autistic community concerns.

ABA is controversial. We present concerns from the autistic community below.

Low Arousal Approaches
Reducing demands and environmental triggers to prevent crisis.

Key principles:

  • Reduce demands when dysregulated
  • Stay calm yourself
  • Minimise environmental stressors
  • Prioritise safety and relationship
Strong logical basis. Consistent with regulation science.

Especially relevant during meltdowns or high stress.

Understanding the ABA controversy
ABA is widely used but also widely criticised, particularly by autistic adults.

Historical trauma

Early ABA included aversive practices (punishment, withholding). While practices have evolved, this history matters.

Goals of compliance

Concerns that goals focus on making children appear "normal" rather than supporting their wellbeing.

Suppression of autistic traits

Reducing stimming and other autistic behaviours may cause harm, even if behaviour is "reduced".

Intensity

40 hours/week of therapy for young children raises questions about childhood, play, and autonomy.

Power imbalance

Adult-directed. Limited child autonomy. Concerns about consent and assent.

Reported outcomes

Many autistic adults report trauma, masking, and mental health impacts from ABA experiences.

We present these concerns not to say all ABA is harmful, but because parents should be aware of this perspective when making decisions.

Ethical goals vs questionable goals

Ethical goals
  • Safety - preventing serious harm to self or others
  • Communication - finding effective ways to express needs
  • Independence - skills that enable autonomy
  • Wellbeing - reducing distress, increasing joy
  • Self-regulation - internal skills, not external control
  • Quality of life - from the child's perspective
Questionable goals
  • Compliance for its own sake
  • Looking "normal" or "indistinguishable from peers"
  • Eliminating stimming that isn't harmful
  • Making adults more comfortable
  • Quiet and still = good
  • Eye contact, social niceties

Red flags to watch for

Focus on compliance over function

Goal is obedience rather than understanding or skill-building.

Suppressing without understanding

Stopping behaviour without asking what need it serves.

Ignoring distress

"Planned ignoring" when child is genuinely distressed, not attention-seeking.

No adaptation for individual

Same programme for everyone regardless of profile.

Parents not involved

No parent training or carryover. Therapy happens "to" child.

Goals that don't benefit the child

Goals about adult convenience, not child welfare.

Extreme intensity

40 hours/week with little time for play, family, rest.

Dismissing autistic perspectives

Refusing to engage with concerns from autistic adults.

Questions to ask any behaviour practitioner
  • What is the function of this behaviour?
  • How will you understand my child's perspective?
  • What happens if my child says no or shows distress?
  • How will goals be set and who decides them?
  • Will my child have opportunities for assent and choice?
  • How do you view stimming and autistic differences?
  • What does success look like from my child's perspective?
  • How will you involve me and teach me strategies?
The key insight

Ask what the behaviour is telling you. Before trying to change a behaviour, understand what function it serves. Often, the most effective intervention is meeting the underlying need differently.

The goal should always be your child's wellbeing and quality of life - not making them look more "normal" or making adults more comfortable.