This comparison draws in part from “Rethinking Assent in Applied Behavior Analysis: Building Rapport, Trust, and Consistency in Treatment” by James Moore, BCBA-D (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 rethinking assent in applied behavior analysis: building rapport, trust, and consistency in treatment, 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 Client Resistance | Treats resistance as a behavior to be managed through contingency manipulation, focusing on maintaining compliance through reinforcement and extinction procedures | Treats resistance as potential communication about the client's experience, warranting examination of whether therapeutic demands, rapport, or environmental factors need modification |
| Role of the Therapeutic Relationship | Relationship is instrumental, serving primarily as a context for delivering behavioral contingencies effectively | Relationship is foundational, with rapport and trust viewed as prerequisites for ethical and effective intervention |
| Response to Refusal | Refusal is typically addressed through planned extinction, redirection, or contingency management to maintain the planned activity | Refusal triggers an assessment of whether the client is genuinely distressed, whether the therapeutic context needs modification, or whether the demand should be adjusted |
| Practitioner Accountability | Practitioner is primarily accountable for achieving behavioral targets and maintaining treatment fidelity to prescribed procedures | Practitioner is accountable for both clinical outcomes and the client's subjective experience of treatment, including their willingness to participate |
| Risk of Harm | Risk of coercive practices that may produce compliance without genuine engagement, potentially damaging the therapeutic relationship and client trust | Risk of under-treatment if practitioners discontinue beneficial activities too readily in response to momentary reluctance |
| Long-Term Outcomes | May produce faster short-term behavior change but risks creating dependence on external contingencies and potential treatment aversion | May produce slower initial progress but builds intrinsic motivation, stronger therapeutic relationships, and more sustainable engagement over time |
| Alignment with Ethics Code | May conflict with Ethics Code provisions regarding assent (Section 2.11) and least restrictive intervention (Section 2.14) if compliance is obtained through aversive means | Aligns with Ethics Code provisions on assent, dignity, and least restrictive intervention but requires careful clinical judgment to balance with effective treatment delivery |
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 rethinking assent in applied behavior analysis: building rapport, trust, and consistency in treatment 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.
Rethinking Assent in Applied Behavior Analysis: Building Rapport, Trust, and Consistency in Treatment — James Moore · 1 BACB Ethics CEUs · $15
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.
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
252 research articles with practitioner takeaways
1 BACB Ethics CEUs · $15 · BehaviorLive
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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.