How Can I Better Integrate Compassionate Care into ABA Education and Practice?

As a university ABA instructor and Board Certified Behavior Analyst (BCBA), I’ve noticed increasing discussion around compassionate care. What exactly does compassionate care mean within the context of ABA, how is it applied in practice, and how can I meaningfully integrate these concepts into my teaching and practice?

Answered by: Reva Mathieu-Sher, EdD., BCBA & Duaa Alzahrani, MSED., BCBA
Duquesne University

Compassionate Care in Applied Behavior Analysis

As an Applied Behavior Analysis (ABA) instructor and a BCBA, you have likely come across the term compassionate care in discussions, articles, or at conferences. But what does the term really mean and why should it matter to you as a practitioner and an educator? Compassionate care in ABA means intentional and systematic attention toward delivering behavioral analytic services in a way that respects and centers the dignity, emotional well-being, and values of the individual receiving ABA treatment (Mathieu-Sher et al., 2024b; Rohrer & Weiss, 2022; Taylor et al., 2019). Compassionate care focuses on empathy, collaboration, and holistic attention to the comprehensive needs of the individual, families, and other professionals supporting them. For BCBAs, this approach can mean a more respectful, empowering, and effective experience throughout the therapeutic process for both clients and families.

Some voices within the disability community and neurodiversity advocates, including some autistics, have argued that the field of ABA lacks sufficient compassion and have raised concerns about some of its approaches (Lynch, 2019; Ram, 2020). Some criticisms of ABA have been related to the use of ABA as an intervention for autistic individuals and warrant our attention (e.g., Leaf et al., 2022). For example, concerns have been shared specific to the intensity of ABA interventions, the use of punishment procedures, and a push for normalization over acceptance. Additionally, criticisms have been shared by some parents of autistic children. In 2019, a survey of parents of autistic children by Taylor et al., noted that ABA practitioners may use too much jargon when communicating with parents, fail to acknowledge their own mistakes, and may be less likely to provide care and compassion that extends to the entire family for an autistic child. A greater focus on compassionate care could address at least some of these concerns.

Since the surfacing of such criticisms, the field of ABA has worked to acknowledge and accept feedback from the disability community, neurodiversity community, and autistic self-advocates (e.g., including autistic speakers at conferences, increased research on teaching assent and self-advocacy, and integrating trauma-informed care). There has also been a variety of research efforts to consider ways that providers implementing ABA practices can systematically and purposefully integrate compassion-based behaviors in its approaches such as teaching interpersonal skills and cultural responsiveness to students of ABA using behavioral skills training (BST) and other behavior analytic strategies (e.g., Bukszpan et al., 2025; Gatzunis, et al., 2023; Mathieu-Sher et al., 2024b, Rohrer & Weiss, 2022).

As a BCBA, you may have many questions related to compassionate care as it relates to ABA. You may also see various agencies and practitioners indicate that they engage in compassion-based ABA practices and you may be unsure what that might mean. In the following sections we provide information about what compassionate care is, why it is important to the field of ABA, and what it might look like within interventions. We also offer sample questions related to compassionate care that a parent may ask when choosing an ABA provider.

The Importance of Compassionate Care in ABA

Behavior analysis isn’t just about techniques and technical application; it’s about relationships and helping to support meaningful behavioral changes and skill acquisition for those we seek to support. Since its inception, the field of Applied Behavior Analysis (ABA) has aimed to support those who have been historically underserved or lacked access to effective treatment (Wolf, 1978). Compassionate care reaffirms and re-centers the foundational mission of ABA by aiming to enhance trust, foster meaningful engagement, and promote socially significant and effective outcomes. It underscores the essential principles and serves as an important reminder that therapy should be ethical, person-centered, and supportive, rather than controlling, compliance-based, or harmful (Penney et al., 2024).

Compassionate Care: Theory to Practice

The term compassionate care originated from the nursing field and continues today (Babaei, et al., 2022). It has also been integrated in physician programs to train more compassion-based medical staff. A helpful way to conceptualize this concept is through the idea of a “bedside manner.” Sometimes medical professionals demonstrate stellar technical skills related to the knowledge and implementation of treatment in their field; however, their interpersonal skills may be lacking or could use improvement. Furthermore, a study by Beach et al. (2006) found that stronger patient–provider relationships are linked to improved treatment outcomes, demonstrating that patient-centered care not only enhances the overall experience of patients but also contributes meaningfully to the effectiveness of care. This is where compassionate care comes in. Compassionate care focuses on providing interventions in a kind, empathetic manner that is focused on assent, openness to feedback, self-advocacy, and self-determination.

In 2019, a seminal article was published which urged practitioners and researchers to consider the role of compassion in ABA (Taylor et al., 2019). This article surveyed parents of children with autism asking them to indicate areas of strength in their interactions with BCBAs and limitations of those practitioners. In addition to many strengths, interpersonal skills were one of the areas that required further attention. An additional article was published in 2020 that asked BCBAs to self-reflect on their own skills and training. Results of that survey indicated that BCBAs viewed the development of interpersonal skills as important and reported that this area was insufficiently addressed in their foundational training. Consequently, they highlighted the need for additional training in interpersonal skill development (LeBlanc et al., 2020).

Given the recent criticisms and the initial data from LeBlanc et al., (2020), ABA practitioners and researchers have considered potential areas of weakness in preparation of BCBAs and systematically set out to refine and increase skills in the identified deficits areas through research, education, and practical application. Following the articles of Taylor et al., (2019) and LeBlanc et al., (2020), Behavioral Analyst in Practice created a special issue to specifically explore how compassionate care could be conceptualized, operationalized, and researched within the field of ABA. This generated an increase in attention and work highlighting how compassion can be taught and utilized within the field. This special issue resulted in review articles and research articles involving compassionate care both within and outside the journal to illustrate how ABA currently integrates compassion and identified continued areas of need for compassion to be further implemented and explored (Gatzunis, et al., 2023; Mathieu-Sher et al., 2024b, Melton et al., 2023; Reinecke et al., 2023; Rohrer & Weiss, 2022). Additionally, in 2022, the BACB made key modifications to the Code of Ethics (BACB, 2022a), which specifically highlights the requirements that BCBAs must treat all clients, caregivers, and colleagues with “compassion, dignity, and respect” (p. 4). In 2024, the BACB also implemented a revised task list now referred to as the 6^th edition Test Content Outline (TCO). The updated TCO includes the requirement of practitioners to demonstrate interpersonal skills such as “accepting feedback, listening actively, seeking feedback and collaborating to establish and maintain professional relationships” (BACB, 2022b, p. 2).

Interventions with a Framework of Compassionate Care

Compassionate care within ABA is not merely a philosophical stance—it is an evidence-aligned, ethical imperative that comes from our roots. It integrates attunement to the individual and family’s lived experiences and individual needs with science-based and supported behaviorally-based practices.

The following table illustrates how compassionate care can be operationalized in intervention settings. It provides examples of specific practices that align with a compassionate framework, as well as contrasting examples that reveal the absence of such practices.

Table 1

Compassionate Care Treatment Elements, Examples, and Non-Examples

Compassionate Care Treatment Elements	Example	Non-example
Respecting client preferences (BACB, 2022, Core Principle 2)	Offering a range of activities and allowing the client to choose between them, even if their choice is unconventional or unexpected.	Forcing participation in a scheduled task despite the client expressing a clear preference to engage in something else.
Collaborating with families on goal development (Gatzunis et al., 2023; Mathieu-Sher et al., 2024b; Roher et al., 2021)	Holding and planning meetings with caregivers to co-develop goals that are culturally and contextually relevant.	Creating treatment goals without family input, input from family only at the start of treatment, or assuming the clinician knows best based on assessment results only.
Implementing client and person-centered social validity checks (Alzahrani & Mathieu-Sher, 2025)	Regularly seeking input from the client or caregivers to ensure that the goals and strategies are appropriate or assessing the client’s preferences through their specific and individual signs of assent.	Using only standard outcome measures without evaluating whether the interventions actually improve the person’s daily life.
Demonstrating perceptiveness and responsiveness by adjusting interventions based on feedback or distress (Hanley, 2021)	Monitoring both subtle and overt client behaviors, including behavioral cues and patterns. Prioritizing the client’s emotional well-being, actively working to reduce distress and address its underlying functions. Clients should be “happy, relaxed, and engaged” (HRE) in treatment.	Extinguishing distress behaviors or continuing an intervention despite repeated protests or signs of significant discomfort because the “data shows it’s effective.”
Using preferred language (Mathieu-Sher et al., 2024a)	Asking clients and families what terminology they prefer (e.g., “autistic person” vs. “person with autism”) and respecting that consistently in writing and vocal words.	Referring to clients in the same way without conferring with them or insisting on clinical language without considering how it may feel stigmatizing or impersonal to some.
Honoring “no” or dissent (Abdel-Jalil et al., 2023; Alzahrani & Mathieu-Sher, 2025; Flowers & Dawes, 2023)	Treating a refusal or “no” as meaningful communication to withdraw of assent from participation, even from a non-vocal client, based on client-specific assent and dissent checklists.	Ignoring protests because the task is part of the program.
Teaching an individual how to access or request items they want or need (Bondy et al., 2022; Cicero, 2024)	Implementing functional communication training (FCT) tailored to teach clients self-advocacy based on the client’s mode of communication (e.g., AAC device, PECS, sign, spoken language).	Teaching the client only programming-related communication or withholding communication devices when distress is observed or when honoring that communication would be inconvenient for the practitioner.
Carefully considering the use of planned ignoring	Carefully considering the use of planned ignoring and limiting it use to specific, data driven, ethically reviewed situations, and pairing it with positive strategies for alternative communication.	Broadly using planned ignoring for any behavior deemed noncompliant, even when the behavior is communicative or a sign of distress.
Prioritizing neurodiverse affirming interventions over normalizing	Supporting a client in developing their own routines, social goals, or stimming behaviors that may help them self-regulate.	Implementing interventions to eliminate behaviors solely because they are atypical without evaluating their function or value to the client (e.g. suppressing self-regulatory stimming strategies that are not harmful, forcing neurotypical social goals, forced prolonged eye contact)
Centering treatment on building skills and limiting any use of forced compliance	Teaching coping skills, communication, and autonomy, rather than focusing on rule-following or compliance for its own sake.	Using physical prompting or repeated demands to gain compliance without assessing the client’s consent or readiness.
Prioritizing safety	Developing and implementing individualized safety plans that consider the client’s history, preferences, and triggers, using trauma-informed approaches. These plans prioritize the client’s emotional and physical safety and incorporate proactive strategies to prevent escalation and de-escalation.	Justifying harsh or restrictive procedures as necessary for safety without considering less intrusive alternatives or the social significance of the behavior, based on others’ views of what’s acceptable.
Providing opportunities for co-regulation throughout the process (Baker et al., 2021; Murray, 2015).	Allowing opportunities for co-regulation (e.g. responsive interactions that provide comfort, support, and modeling to another person to support understanding, expressing, and modulating their thoughts, feelings and behaviors with a familiar and self-regulated adult throughout intervention and treatment in all settings.	Allowing co-regulation opportunities only for younger clients in homes or assuming that clients who can self-regulate in some environments or situations can self-regulate in all environments or situations.

Systematic Instruction and Integration of Compassionate Care in ABA

ABA is about breaking down concepts to teach and increase skills for everyone who needs it, including practitioners. All practitioners benefit from systematic instruction in compassionate care, including opportunities for practice, feedback, and reflection. Integrating a compassion-based framework into the delivery of treatment and intervention not only supports the development of essential interpersonal skills but also has the potential to enhance clinical outcomes, increase social validity, and foster long-lasting, trusting relationships between BCBAs and those they serve and work with.

The ethical code that BCBAs are required to follow indicates that practitioners must treat clients with compassion, dignity, and respect. Some BCBAs do not feel the need to emphasize that their services are compassionate because they believe that it is required and a basic element of the field. However, there is no such thing as too much compassion.

As BCBAs we should always be striving to better our field and the services that we provide. At different historical points in our field, practices were used that are no longer used or used less often given the negative side effects that were discovered to be associated with these interventions. Just because we can change behavior and have the technical skills to do so doesn’t always mean that we should. ABA has always been concerned with supporting individuals who previously had minimal access to effective treatment or rights to express their wants and needs (Wolf, 1978). Integration and research related to compassionate care will continue to refine and enhance those efforts.

Questions to Better Understand How Compassion is Prioritized in Practice

After reading this article, you may find yourself wanting to learn more about how BCBAs and ABA agencies can incorporate and prioritize compassion-based practices in their interventions and treatment. Below is a list of potential questions parents might ask, along with linked resources to help deepen your understanding of compassion-centered approaches in ABA.

1. 1. How will you prioritize my goals for my child and my child’s goals for themselves if/when they are able to advocate for themselves?
   2. How does your clinic/agency consider assent in their treatment and intervention procedures?
   3. How will you respond to my child if they show signs of distress?
   4. How will you get to know my child and who they are as an individual?
   5. How will you integrate their motivations, interests, and preferences into their programming?
   6. How will you balance teaching my child skills and addressing their challenging behaviors?
   7. How will you communicate with me to help me to understand my child’s needs and progress in a way that I can understand?
   8. How will our input be incorporated over the course of our work together?

Conclusion

Compassionate care in ABA is not just a trend but a necessary continuing evolution in the field. Compassionate care reinforces the importance of empathy, respect, and individualized support for those receiving ABA services. As practitioners in the field continue to listen to and learn from autistic individuals and advocates, it is essential to systematically and intentionally integrate compassionate practices to ensure interventions remain both ethical and effective. Ultimately, fostering compassion-based practices benefits everyone involved through promoting meaningful, respectful interventions and strengthening therapeutic relationships with clients, families, and professionals both within and beyond the field of ABA.

References

Alzahrani, D., & Mathieu-Sher, R. (2025, May 26). Examining the effectiveness of a behavior analytic intervention conducted within multi-level person-centered compassionate care model. [Conference session]. 51st Annual Convention of the Association for Behavior Analysis International, Washington, DC.

Abdel-Jalil, A., Linnehan, A. M., Yeich, R., Hetzel, K., Amey, J., & Klick, S. (2023). Can there be compassion without assent? A nonlinear constructional approach. Behavior Analysis in Practice, 1-12. https://doi.org/10.1007/s40617-023-00850-9

Babaei, S., Taleghani, F., & Farzi, S. (2022). Components of compassionate care in nurses working in the cardiac wards: A descriptive qualitative study. Journal of Caring Sciences, 11(4), 239–245. https://doi.org/10.34172/jcs.2022.24

Beach, M. C., Keruly, J., & Moore, R. D. (2006). Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? Journal of general internal medicine, 21(6), 661–665. https://doi.org/10.1111/j.1525-1497.2006.00399.x

Behavior Analyst Certification Board. (2022a). BCBA test content outline (6th ed.). https://www.bacb.com/wp-content/bcba-outline-6thEd/

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Baker, J. K., Fenning, R. M., & Moffitt, J. (2021). Internalization of emotion co-regulatory support in children with ASD. Encyclopedia of Autism Spectrum Disorders, 2516–2519. https://pmc.ncbi.nlm.nih.gov/articles/PMC9720497/

Bondy, A., Horton, C., & Frost, L. (2020). Promoting functional communication within the home. Behavior Analysis in Practice, 13(2), 321-328. https://doi.org/10.1007/s40617-020-00439-6

Bukszpan, A. R., Leaf, J. B., O’Brien, J. G., Lewis, A., Kristiansen, S., Lord, J., Axe, J. and Weiss, M. J. (2025), Utilizing the Teaching Interaction Procedure to Train Special Education Teachers in Behavioral Artistry. Behavioral Interventions, 40: e70017. https://doi.org/10.1002/bin.70017

Cicero, F. (2024). A treatment summary of functional communication training. Science in Autism Treatment, 21(7).

Flowers, J., & Dawes, J. (2023). Dignity and respect: Why therapeutic assent matters. Behavior Analysis in Practice, 16(4), 913–920. https://doi.org/10.1007/s40617-023-00772-6

Gatzunis, K. S., Weiss, M. J., Ala’i-Rosales, S., Fahmie, T. A., & Syed, N. Y. (2023). Using behavioral skills training to teach functional assessment interviewing, cultural responsiveness, and empathic and compassionate care to students of applied behavior analysis. Behavior Analysis in Practice, 16(4), 938–962. https://doi.org/10.1007/s40617-023-00794-0

Hanley, G. P. (2021, September 9). A perspective on today’s ABA. Practical Functional Assessment. https://practicalfunctionalassessment.com/2021/09/09/a-perspective-on-todays-aba-by-dr-greg-hanley/

Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. (2022). Concerns about ABA-based intervention: An evaluation and recommendations. Journal of Autism and Developmental Disorders. 52(6), 2838-2853. https://doi.org/10.1007/s10803-021-05137-y

LeBlanc, L. A., Taylor, B. A., & Marchese, N. V. (2020). The training experiences of behavior analysts: Compassionate care and therapeutic relationships with caregivers. Behavior Analysis in Practice, 13(2), 387–393. https://doi.org/10.1007/s40617-019-00368-z

Lynch, C. L. (2019, March 28). Invisible abuse: ABA and the things only autistic people can see. https://neuroclastic.com/2019/03/28/invisible-abuse-aba-and-the-things-only-autistic-people-can-see/

Mathieu-Sher, R., Green, B., & Mcgoey, K. (2024a). Respecting autistic individuals through compassionate words and actions. Communiqué, 53(3), 24–26. https://eric.ed.gov/?id=EJ1446360

Mathieu-Sher, R., Johnson, P., Straub, E., Lao, A., Alzahrani, D., McCallum, E., & Schmitt, A. (2024b). Teaching compassionate-based behaviors across communication partners to students of applied behavior analysis: A preliminary investigation of comparative effectiveness. Discover Education, 3(1), Article 101. https://doi.org/10.1007/s44217-024-00198-4

Melton, B., O’Connell‑Sussman, E., Lord, J., & Weiss, M. J. (2023). Empathy and compassion as the radical behaviorist views it: A conceptual analysis. Behavior Analysis in Practice. Advance online publication. https://doi.org/10.1007/s40617-023-00783-3

Murray, D. W., Rosanbalm, K., Christopoulos, C., & Hamoudi, A. (2015). Self-regulation and toxic stress: Foundations for understanding self-regulation from an applied developmental perspective (OPRE Report # 2015-21). Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/opre/report/self-regulation-and-toxic-stress-foundations-understanding-self-regulation-applied

Penney, A. M., Bateman, K. J., Veverka, Y., Luna, A., & Schwartz, I. S. (2024). Compassion: The eighth dimension of applied behavior analysis. Behavior Analysis in Practice. Advance online publication. https://doi.org/10.1007/s40617-023-00888-9

Ram, J. (2020, June 2). I am a disillusioned BCBA: Autistics are right about ABA. https://neuro clastic.com/2020/06/02/i-am-a-disillusioned-bcba-autistics-are-right-about-aba/

Reinecke, D., Lasley, J., & Cirincione-Ulezi, N. (2023). Coursework in compassion and behavior analysis training programs. Behavior Analysis in Practice. Advance online publication. https://doi.org/10.1007/s40617-023-00815-y

Rohrer, J. L., Marshall, K. B., Suzio, C., & Weiss, M. J. (2021). Soft skills: The case for compassionate approaches or how behavior analysis keeps finding its heart. Behavior Analysis in Practice, 14(4), 1135–1143. https://doi.org/10.1007/s40617-021-00563-x

Rohrer, J. L., & Weiss, M. J. (2022). Teaching compassion skills to students of behavior analysis: A preliminary investigation. Behavior Analysis in Practice, 16(3), 1–20. https://doi.org/10.1007/s40617-022-00748-y

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2019). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654–666. https://doi.org/10.1007/s40617-018-00289-3

Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11(2), 203–214. https://doi.org/10.1901/jaba.1978.11-203

Reference for this Article:

Mathieu-Sher, R., & Alzahrani, D. (2025). Clinical Corner: How can I better integrate compassionate care into ABA education and practice? Science in Autism Treatment, 22(7).

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