This comparison draws in part from “Invited Speaker: Navigating Assent Based Decision Making” by Karen Nohelty, M.Ed., BCBA (BehaviorLive), and extends it with peer-reviewed research from our library of 27,900+ ABA research articles. The decision framework, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →One of the most consequential decisions a behavior analyst makes is not just what intervention to use, but how to approach the clinical question in the first place. For invited speaker: navigating assent based decision making, the difference between an evidence-based, individualized approach and a traditional, protocol-driven one can significantly impact outcomes.
This guide lays out the key factors side by side to support your clinical decision-making.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| View of Noncompliance | A behavior to be reduced through extinction, reinforcement of compliance, or other procedures | A potential communication of dissent requiring assessment and respectful response |
| Client Autonomy | Subordinated to treatment goals determined by the treatment team | Respected as an ongoing right that informs treatment planning and session management |
| Therapeutic Relationship | Practitioner directs; client follows | Collaborative; practitioner seeks conditions under which client willingly engages |
| Response to Refusal | Continue demand; prevent escape; reinforce eventual compliance | Pause activity; explore modifications; conduct risk-benefit analysis if necessary |
| Self-Advocacy Development | May inadvertently teach that refusal is ineffective, reducing future self-advocacy | Reinforces appropriate refusal, building self-advocacy skills that generalize |
| Risk of Harm | Risk of psychological harm from repeated overriding of dissent; potential for coercive dynamics | Risk that treatment goals may be delayed; requires robust decision-making framework for safety-critical targets |
| Alignment with Ethics Code | Increasingly difficult to reconcile with Section 2.11's assent requirement | Directly implements the Ethics Code's assent provisions |
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Use this framework when approaching invited speaker: navigating assent based decision making in your practice:
Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?
YES → Proceed to assessment NO → Document reasoning, monitor
A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.
YES → Select evidence-based approach matched to function NO → Complete assessment first
Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.
YES → Proceed with collaborative plan NO → Engage in shared decision-making
This course covers the clinical and ethical dimensions in detail with structured learning objectives and CEU credit.
Invited Speaker: Navigating Assent Based Decision Making — Karen Nohelty · 1 BACB Ethics CEUs · $30
Take This Course →We extended this decision guide with research from our library — dig into the peer-reviewed studies behind each approach, in plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
233 research articles with practitioner takeaways
1 BACB Ethics CEUs · $30 · BehaviorLive
Research-backed educational guide
Research-backed answers for behavior analysts
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.