Dignity and Respect: Why Therapeutic Assent Matters

Flowers et al. (2023) wrote a position paper. They say ABA needs its own assent rules for therapy, not just research.

The paper targets neurodiverse clients who may not speak or sign. It argues that dignity still matters even when consent is hard to get.

The authors found no existing assent guide that fits day-to-day ABA sessions. They outline steps to check willingness before each activity.

The paper stresses that assent is ongoing, not a one-time yes. If the client shows distress, you stop, even if the goal is on the plan.

Allen et al. (2024) extends this idea. They add a neurodiversity-affirming checklist that uses identity-first language and keeps asking for assent every session.

Rajaraman et al. (2022) push for trauma-informed care. Both papers want you to pause when the client signals no, but Rajaraman focuses on choice and warning cues, while Flowers focuses on clear assent steps.

Vollmer et al. (2025) call for ongoing social-validity audits. Flowers fits here because checking assent is one way to audit your session in real time.

You can start using the assent pause today. Before each demand, watch for body cues, give a break option, and honor a clear no. This keeps therapy humane and may lower problem behavior that stems from feeling trapped.