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An Assent filled Coffee Date, Part 1

Bryan, the new master’s level behavior analyst and his introduction to consent and assent 

Bryan is a newly minted BCBA® who has been working in a small ABA clinic for about a year. He oversees 8 cases, all of whom include young children and teens diagnosed with autism spectrum disorder and/or intellectual disability (ASD/ID). His scope of competence includes designing behavior analytic language and skill-acquisition programs; teaching daily living, personal safety, and social skills; and caregiver training. He attended the annual conference of the Association for Behavior Analysis International (ABAI) in May of 2022 and encountered several panels and discussions regarding consent and assent procedures in research.

He knows that his work organization obtains consent from caregivers (legally authorized representatives) for service delivery, but he is not involved in that process. And, never having conducted research (he earned his master’s degree from an online program that did not require an empirical thesis), he feels a little lost as to how obtaining consent and assent in research relates to practice. 

So, with a newly stoked fire–an establishing operation for information–he does what any good practitioner might do: He makes two coffee dates. The first is with himself, in order to learn more on his own. The second is with his coworker, Sia, who is a few years his senior, to discuss what he has learned in more detail. 

During his coffee date with himself, he conducts a Google Scholar search of the terms “consent, assent, behavior analysis,” and finds a very interesting article by Morris et al. (2021). He learns many things from this article, such as how all federally funded institutions conducting research with human participants have to form Institutional Review Boards (IRBs), which approve or deny various aspects of research protocols.

When reviewing potential research, one of the things IRBs look for are procedures for obtaining informed consent (written agreement to participate in research); and, if the research includes minors or people unable to provide their own consent, they should also have procedures for obtaining assent (a verbal agreement to participate from someone not legally authorized to provide their own consent). However, assent is sometimes waived for research participants with ASD/ID, for a few reasons. [See Morris et al., 2021, for more details.]

He vigorously highlights the sentence, “despite assent requirements likely being waived for potential research participants with ASD and [IDs] through the federal requirements, behavior analysts must seek ways to empower the individuals they serve with self-determination and choice when possible” (Morris et al., 2021, p. 1308). He is also intrigued by the authors’ recommendations for obtaining assent with people who might not be able to answer the question, “Do you want to do this?” but he definitely needs more information. 

He feels like his head is spinning. Although very informative, the Morris et al. (2021) article discussed consent and assent in research. In fact, the first sentence of the article was, “Researchers are ethically obligated to obtain permission from potential research subjects before enrolling them in a study” (p. 1300, Morris et al., 2021). Bryan uses within-subject experimental designs, but he does not consider himself to be a researcher. He is left wondering if and how obtaining consent and assent in research is related to obtaining consent and assent in practice. 

He then looks to the Ethics Code for Behavior Analysts (BACB®, 2020), hereafter The Code. There, in section 2.11, he learns that behavior analysts are responsible for obtaining informed consent under certain conditions, and that they are responsible for obtaining assent when applicable (p. 11). He knows that his clients’ caregivers give informed consent prior to service delivery, but he makes a note to ask Sia about the specifics, such as how and when those forms are updated. Given the consent process is out of his hands (for now), he focuses on assent. What does that mean, “get assent when applicable,” he wonders. 

He returns to The Code’s glossary, where assent is defined as, “vocal or nonvocal verbal behavior that can be taken to indicate willingness to participate in research or behavioral services by individuals who cannot provide informed consent (e.g., because of age or intellectual impairments). Assent may be required by a research review committee or a service organization. In such instances, those entities will provide parameters for assessing assent” (p.  7, BACB, 2020). 

Hmm. That last sentence makes his coffee-fueled heart beat even faster. Bryan does not know if his service organization has policies or procedures related to obtaining assent. He makes a note to ask Sia about their organization’s parameters for assessing ascent. 

He checks his watch. Shoot! How has it already been 3 hours? Before he leaves to pick up his kids, he jots down a few more questions for his meeting with Sia: 

Given most researchers do not mention assent procedures (Morris et al., 2021) and there are no standard recommendations for obtaining assent in research or practice, where do we even start? 

Under what conditions do we need or not need to obtain consent? 

If researchers ever do develop models for obtaining assent in research, how would those models be translated to a comprehensive treatment setting, where sessions times are longer and there are a variety of goals to work on? 

His hand is cramping, and it’s a race against the clock, but his questions keep coming: 

What does assent entail? How often do we assess for it? 

Is any instance of challenging behavior a withdrawal of assent? Does it depend on the circumstances? For instance, if I am teaching a client to count money, tact 2-D items, or imitate and the client engages in challenging behavior, is that a withdrawal of assent to participate in the teaching procedures as designed? At that moment, should I cease instructional trials? 

If I cease instruction (service delivery) for some period of time, will it have implications for billing/reimbursement from the client’s insurance company? 

He glances at his watch again. Oh no – the kids are waiting! Last question before he closes his notebook and rushes to his car: 

Do you know of any good trainings for designing treatments with assent front and center?

References

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/. Accessed on November 8, 2022, https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-220316-2.pdf.

Morris, C., Detrick, J. J., & Peterson, S. M. (2021). Participant assent in behavior analytic research: Considerations for participants with autism and developmental disabilities. Journal of Applied Behavior Analysis, 54(4), 1300-1316.

Interested in learning more about Assent and Consent (and getting a cheap CEU)?

Click here to check out the Minicourse we go into depth on all these questions!