As a behavior analyst I know that I am required by the BACB Ethics Code to obtain both consent and assent before starting and during treatment. Consent seems straight forward, but I’m still a little confused about assent and what it actually looks like. Do you have any recommendations for obtaining assent in practice?

Answered by
Alison Moors Lipshin, MA, BCBA
Precision Learning Solutions, PLLC

What is Assent in ABA Intervention

Photographed by kaboompics.com (pexels.com)

As behavior analysts, thinking about ways to obtain assent from our learners during our practice is not only aligning with the BACB ethics code, but it is an important way to honor a learner’s voice and create a learning environment based on mutual trust and respect! Most importantly, honoring a learner’s assent allows the individual to acquire advocacy skills and autonomy, which could potentially result in reduced instances of exploitation and overall client dignity (Flowers & Dawes, 2023).

In the current Behavior Analyst Certification Board’s (BACB) Ethics Code1 for Behavior Analysts, 2.11 Obtaining Informed Consent, reads “Behavior analysts are responsible for knowing about and complying with all conditions under which they are required to obtain informed consent from learners, stakeholders, and research participants.” Practitioners “are responsible for obtaining assent from learners” (Behavior Analyst Certification Board, 2020). When embarking on any ABA journey, parents and/or guardians are typically the ones who give consent for treatment. However, what about gaining assent from the learners?

As previously noted, section 2.11 of the Ethics Code indicates that behavior analysts are responsible for both assent and consent. In fact, the BACB code indicates obtaining assent from learners when applicable, but practitioners and caregivers can strive to consistently honor assent and assent withdrawal, regardless of the perceived abilities of the learner. Of course, when in situations of danger/harm/society rules and laws, interventionists still need to use their clinical judgement in the moment to assess when or if assent withdrawal should be honored. It is imperative that assent-based practices should not put learner and/or others’ safety at risk.

What is the Difference Between Consent and Assent?

CONSENT can either be a noun or a verb. It is a legal agreement and permission to start an outlined treatment plan. Either a signature by a legal guardian or the learner themselves agrees to the start of treatment. In the case of ABA programming, it is the guardian’s approval of the proposed treatment plan and the agreement to abide by the policies and procedures outlined. This approval also includes documentation of treatment risks/benefits and a clear definition of services. As a verb, one can “consent to treat” as in a doctor’s office.

ASSENT is in addition to consent. This is best described as the learners’ agreement to participate. Many times, this is the case of the person who legally cannot provide informed consent, as with a learner who is a minor or a person with disabilities who requires a parent or guardian to legally make decisions. As in the case of consent, assent should also be provided voluntarily and without coercion (Breaux & Smith, 2023; Morris et al., 2024).

The learner can engage in “assent withdrawal” behaviors at any time. Assent withdrawal looks like the learner is no longer willing to participate in treatment at any given time. This could be communicated simply with a “no” when asked if they are ready to go to class, or a learner walking away from the treatment table before the intervention activity is completed. Since assent can be withdrawn at any time, the learner may be actively engaged in an activity in one moment but then swipe the materials off the table the next.

Learners can provide assent or withdrawal assent across a variety of variables, including instructors, tasks, environments/locations, stimuli, treatment features/conditions (e.g., sensory stimulation, location transfer to/from, physical prompts/redirection, etc.). Data collection systems can and should be designed to capture all these variables. For example, data can illustrate which programs or tasks in which the learner regularly withdraws assent and, in contrast, which ones they willingly engage in. Is there a pattern of withdrawals per day, per interventionist, per environment? Does the topography of withdrawing assent change? For example, the student sometimes throws the stimuli vs. the student uses an advocacy statement to stop instruction. Each set of data collected should be analyzed and treatment protocols adjusted to meet the needs of the learner both within sessions and across sessions (Abdel-Jalil et al., 2023; Breaux & Smith, 2023).

Practitioners should also prioritize goals that encourage the learners themselves to willingly participate in, or appropriately advocate withdrawal from, the treatment experience. The skills needed to actively engage in prosocial assent and assent withdrawal can, and should, absolutely be taught.

Why is Assent Important?

Partnering with learners by honoring their assent and assent withdrawal moment by moment during intervention is a critical form of autonomy for the learner. The ability to make one’s own decisions, without being controlled by anyone else, is a fundamental human right and therefore a foundationally critical skill to teach. Without autonomy, vulnerable individuals may fall prey to being controlled by what others do, think, and feel, and adapt accordingly. Therefore, giving up their own voice.

Operationally Define Assent and Assent Withdrawal for an Individual Learner: What Does this Look Like?

To align intervention procedures with assent-based practices, the practitioner should first identify the learner’s current behaviors whose hypothesized function may be escaped. Then, we can set out to operationally define what assent and assent withdrawal is for each individual learner. One suggestion is to revisit a current Functional Behavior Assessment (FBA) and look at any behaviors identified as escape maintained. If we reframe “escape” into “withdrawing assent,” it may clear up where to start switching the focus of programming. Looking at functionally equivalent, functional communication and other pro-social behaviors, is a great first step.

Vocal-verbal Communication:

Assent: Can the student answer a functional “yes” when the teacher says, “Can we start?” Securing students’ attention before delivering instruction AND asking for permission to start are examples of the simplest and most straightforward ways of gaining permission/assent from the learner. In addition, instructors can allow the student to drive the intervention session by picking the order of programs (either by a simple “What do you want to do next?” or by having the student list the day’s agenda). Learners can also show assent by asking clarifying questions about the topic/lesson, or if the student independently asks to find out more about the topic.

Assent withdrawal: The student clearly says “no” when asked if ready to work. Vocal-verbal students may also engage in negative self-talk and/or negative statements about the task/materials/instructor/environment. This could also look like attempts to change the subject or trying to steer the instructor off-task.

Non-vocal-verbal Communication:

It is important to note that vocal-verbal communication from the learner is not required to obtain their assent or honor their assent withdrawal. These can also be assessed through their non-vocal language just as (e.g., body movements, gestures, engagement vs. disengagement with the task, etc.).

Assent: During instruction/intervention, does the learner seem to “lean into” the lesson? Do they independently initiate the task (organize materials, independently start the checklist)? Or maybe the student does not want to leave the table when finished? Also, students might be observed to approach the instructor (independently/without prompts) when they see the teacher organizing the task or taking out the related materials. Finally, non-vocal cues and/or behavioral indications can be observed, such as smiles, nods, laughs/giggles, relaxed and engaged facial affect.

Withdrawing Assent: These behaviors tend to be associated with task avoidance: elopement from the treatment area and/or instructor, swiping away materials, “ignoring” the direction, and/or turning their body away from the intervention space. However, interventionists may also want to reframe other, more traditionally defined maladaptive behaviors as withdrawing assent. Such as aggression, property destruction, and self-injury.

In Summary

Gaining assent from learners during treatment is not only outlined in the BACB Ethics Code as a requirement when applicable, honoring a learner’s assent/assent withdrawals should be part of a complete model of intervention in which a learner’s “uncoerced assent to participation is critical to all treatment-based decisions, whether these decisions occur within a single treatment session or across multiple treatment sessions.” (Breaux & Smith, 2023). In other words, honoring a learner’s voice. If behavior analysts are still confused about what assent actually looks like in practice, Table 1 outlines some quick definitions for what IS and IS NOT generally understood about assent-based practices in ABA programming.

Table 1: Assent Based Practices in ABA

What it IS What it IS NOT
Good teaching/implantation/programming Training up “brat-ism”
It’s when we instruct “WITH” the learner not “TO” the learner. Never placing demands
Learner version of feedback for our teaching/intervention Doing only what the learner likes/wants to do
Data based decisions focused on learner willingness to participate Lowering expectations for work completion and/or learner outcomes
Listening to autistic voices and self-advocates Getting nothing done/not making progress on goals
Learning from our mistakes as a field related to client autonomy Never returning to the task
Growing from our mistakes as individual practitioners related to client autonomy Relinquishing “instructional control”

For guardians and practitioners to ensure that they are, in fact, honoring their learner’s voice, Table 2 illustrates a sample checklist for reference when auditing their current intervention practices for each individual learner:

Table 2: Sample Checklist

Do the program materials CLEARLY outline: Evidence of? Yes/No
Operationally defined behaviors related to assent and assent withdrawal
Interobserver reliability with regard to defined assent and assent withdrawal behaviors
Within session and across session data-based decision-making protocols for analyzing assent-based programming
Include specific instructional programs related to increasing prosocial advocacy behaviors
Specific data collection protocol for tracking assent and assent/withdrawal

Where can I go to learn more about assent within ABA practices?

References

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 Practice 16(2), 123-130. https://doi.org/10.1007/s40617-023-00850-9

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

Breaux, C., & Smith, K. (2023) Assent in applied behavior analysis and positive behavior support: Ethical considerations and practical recommendations, International Journal of Developmental Disabilities, 69(1), 111-121. https://doi.org/10.1080/20473869.2022.2144969

Fabrizio, M. A. (2005, October). Voting with their feet: The role of assent in behavior analytic intervention for children. Paper presented at the Going Beyond Expectations: Unique Solutions in Autism Education Conference. https://docplayer.net/22287468-Creating-for-children-the-aba program-companion.html.

Flowers, J., & Dawes, J. (2023). Dignity and respect: Why therapeutic assent matters. Behavior AnalysisPractice. 16(6), 913-920. https://doi.org/10.1007/s40617-023-00980-4

Morris, C., Oliveira, J. P., Perrin, J., Federico, C. A., & Martasian, P. J. (2024). Toward a further understanding of assent. Journal of Applied Behavior Analysis, 57(2), 304- 318. https://doi.org/10.1002/jaba.1063

Rajaraman, A., Austin, J. L., Gover, H. C., Cammilleri, A. P., Donnelly, D. R., & Hanley, G. P. (2021).Toward trauma-informed applications of behavior analysis. Journal of Applied Behavior Analysis. 55(1), 40-61. https://doi/abs/10.1002/jaba.881

Tiberius, R. (1993). The why of teacher/student relationships. Essays on Teaching Excellence, 5(8). A publication of The Professional & Organizational Development Network in Higher Education. http://www.podnetwork.org

Reference for this article:

Lipshin, A. M. (2025). Clinical Corner: What is “assent” in ABA intervention? What learners, guardians, and intervention providers should consider. Science in Autism Treatment, (22)5.

Related ASAT Articles:

 
#ChallengingBehavior #EarlyCareerAndStudents #Safety #TrainingAndSupervision

Print Friendly, PDF & Email