Where do we stand on the ABA/PBS controversy?
Dimensions believes that support should always be person-centred and designed to promote improved quality of life for the person. As such issues of choice, dignity and respect are of equal importance with safety, health promotion and positive support (as opposed to reactive care.) We are aware of the controversy linked to Applied Behaviour Analysis (ABA) and Positive Behaviour Support (PBS) and have sought to define our position in this regard.
ABA has its roots in experimental psychology dating back to the turn of last century and adapted methods of measurement to understanding behaviour and how change in behaviour can be demonstrated. Historically this has sometimes been applied in ways that were neither appropriate, compassionate and were, frankly ineffective.
“When my son was little and we thought he had ‘bad behaviour’ we sought ABA to try to change his behaviour. That helped us learn that the behaviour was a communication (not naughtiness), and that we needed to learn how to avoid putting him into unmanageable situations. Then we learned about person centred practice and now we use positive behaviour support to ensure that he can manage, cope and stay regulated. It is helpful to us to be able to think about what happens before he gets distressed so that we can prepare him better for difficult situations. It also helps us train his support team to support him really well.”
– Kate, Dimensions family consultant
Over the years, ABA has changed to ensure that cruel, unnecessary and inappropriate ‘treatment’ stopped; the training of practitioners now comprehensively discourages any such practice and has a strong ethical framework. In the UK these practices have, quite rightly, been subject to scrutiny and are not permitted by professional and regulatory guidelines. Also, many would now be in direct contravention of the Human Rights Act as inhumane and degrading treatment.
Despite this progress, ABA continues to be viewed by some as controversial. Some critics perceive that it identifies the ‘problem’ within the individual and not as part of a larger context. Others remain concerned about elements of historical theory and practice which stopped being a mainstream focus of academic psychology back in the mid 1980’s.
PBS first emerged in the 1980s in response to rising concerns over ABA practices of the time. PBS continues to be informed by some of the theory and applications developed in ABA whilst having at its heart a person-centred and trauma-informed model.
PBS seeks to understand the function that a behaviour of distress serves as opposed to simply describing it. So PBS practitioners start by recognising that a behaviour of distress might have developed as a unique way of communicating a need, wish or emotion that the person has developed in previous environments or by traumatic experiences.The best available evidence, and clinical guidelines support the use of PBS as both a governing framework to improve the quality of someone’s life and an approach to reduce the probability of behaviours of distress by changing the environment, how people react and interact with someone and developing a greater understanding and relationship with them.
PBS is a widely used and person-centred approach to identifying and meeting a person’s support needs, and is most commonly used to support people with learning disabilities, some of whom may also be autistic. All of our behaviour specialists follow the framework from the PBS Academy and the practice guidelines set out by the PBS Alliance and the British Institute of Learning Disabilities.
“Our son had such behaviours of distress that he was referred – fortunately never admitted – to the local ATU.
His behaviour has changed beyond recognition since his team have been doing PBS with him. Temper outbursts are rare. He still gets anxious but tends to express it using muttered insults to staff or in sending me WhatsApp messages. Encouragingly, he now says sorry to staff when he’s been rude to them. I never ever expected that to happen.
For my son and his support staff PBS has made life much less stressful and happier.”
– Mum of a person Dimensions supports
Our PBS team works with the person as an individual alongside their support network (family, friends and partner) to understand why that person’s behaviour of distress occurs. In particular this focuses on how their environment impacts upon them (thinking about physical environment, changes, noises, other people etc) and to find ways to ensure that the person feels safe and secure. As such, PBS is a done with as opposed to a done to approach and is more consistent with Dimensions’ philosophy of support and increased individual choice, autonomy and independent citizenship.It also involves minimizing the circumstances in which the person feels distressed or that their needs and wishes are not being met ….in short changing the environment or how we support the person.
In Dimensions our clinical team includes Positive Behaviour specialists alongside Clinical Practitioners and leadership of our health and wellbeing initiatives all of whom can provide highly specialist advice and consultancy to ensure that we support people in the best way we can.