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Youth with autism spectrum disorder (ASD) often face challenges in social communication, making it difficult to report internal states like pain or emotional distress. This is particularly problematic for those with profound autism who are minimally speaking or those with limited nonverbal expressivity during affective states. In the absence of reliable verbal or nonverbal cues, caregivers are frequently left to interpret internal states, contributing to increased risk for unpredictable aggressive or self-injurious episodes and reduced ability to intervene proactively (). Objectively measured biomarkers of internal states may help bridge communication gaps and enable preventative interventions. Wearable biosensors offer an opportunity to objectively monitor changes in autonomic physiology (e.g., heart rate variability). While autonomic physiology is affected by various activities (e.g., exercise, sleep) it can also vary with emotional states (). For instance, sympathetic arousal is associated with increased psychosocial stress while parasympathetic activation is associated with increased emotion regulation (). As such, physiological signals may serve as useful correlates of internal states, especially when interpreted within the context of behavioral events. Increasingly, ASD researchers are leveraging computational methods to predict the onset of challenging behaviors from physiological signal data (; ). If algorithms applied to physiological data can accurately predict future challenging behaviors, they may be integrated into mobile systems to alert caregivers and other support professionals of imminent behaviors. Wearable biosensors hold promise for improving behavioral health monitoring in ASD, but their use must be guided by ethical and inclusive research practices. Individuals with profound autism or high behavioral acuity are often underrepresented in research due to logistical and sensory challenges (). Sensory sensitivities, common in up to 90% of those with ASD (), may limit biosensor tolerability. While systematic desensitization is appropriate for medical procedures (), less intensive, participant-centered approaches are preferable for research (). This report shares our experiences implementing a wearable biosensor protocol with youth with autism requiring high levels of support to inform future inclusive research practices.