These answers draw in part from “Invited Speaker: Navigating Assent Based Decision Making” by Karen Nohelty, M.Ed., BCBA (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Consent is legal authorization for treatment provided by a person with legal authority, typically a parent or guardian. Assent is the client's own ongoing agreement to participate in treatment activities, communicated through observable behavior. Many individuals receiving ABA services cannot provide legal consent due to age or guardianship status but constantly communicate their willingness or unwillingness to participate through their behavior. Both consent and assent are ethically required under the BACB Ethics Code, and they serve different but complementary functions: consent authorizes services, while assent reflects the client's real-time experience of those services.
Assent indicators include approaching therapy materials, following instructions with relaxed or positive affect, initiating interaction with the therapist, making eye contact, smiling during activities, and sustained engagement across tasks. Dissent indicators include turning away from materials or the therapist, pushing materials away, attempting to leave the therapy area, crying, covering ears or eyes, going limp, aggression, self-injury, gaze aversion, body stiffening, and cessation of previously engaged behavior. These indicators are individualized, and what constitutes a clear signal varies across clients. Identifying each client's specific indicators requires careful observation and caregiver input.
A graduated response is recommended. First, honor the dissent by pausing or withdrawing the activity and offering a brief break. If the client re-engages, continue with possible modifications. If dissent persists, modify the activity by reducing difficulty, changing the approach, or substituting an alternative targeting the same skill. If dissent continues and the skill is clinically important, conduct a formal risk-benefit analysis involving the supervising BCBA. Decisions to continue treatment over dissent should be documented, time-limited, and subject to continuous review. The response should always demonstrate respect for the client's communication.
Traditional compliance training targets increased following of instructions, often using escape extinction or reinforcement for compliance, treating noncompliance as a behavior to be reduced. Assent-based practice reconceptualizes noncompliance as potential dissent that communicates the client's experience and preferences. Rather than training the client to comply regardless of their willingness, assent-based practice trains the clinician to recognize, respect, and respond to the client's communications while seeking to make treatment engaging enough that active assent is the norm. The shift is from controlling client behavior to creating conditions where clients willingly engage.
A structured risk-benefit analysis evaluates several factors: the severity and probability of harm if the skill is not taught, the severity and probability of harm from proceeding over dissent, the availability of alternative risk mitigation strategies, and the individual's and family's preferences. Safety-critical targets such as elopement prevention or pica intervention may warrant continued treatment with ongoing dissent in specific circumstances, but this decision should be made by the treatment team with full documentation, not by an individual clinician in the moment. Even in these cases, the team should continuously seek modifications that reduce dissent while maintaining safety.
Individuals who can clearly communicate their agreement or refusal are better protected from abuse and exploitation, more effective at self-advocacy, and more likely to have their preferences respected across environments. Many individuals receiving ABA services currently express dissent through challenging behavior because they lack more conventional means of refusal. Teaching functional dissent communication, such as using a stop card, signing finished, or pressing a break button, simultaneously reduces challenging behavior, increases communication, and builds skills that generalize beyond the therapy setting. This may be among the most protective skills a behavior analyst can teach.
Track the proportion of session time during which active assent indicators are observed, the frequency and duration of assent withdrawal episodes, which activities or conditions occasion withdrawal, the effectiveness of response protocols, and the development of assent/dissent communication skills over time. Review this data in supervision alongside clinical outcome data. High rates of assent withdrawal for specific activities signal the need for treatment plan modification. Persistent patterns of dissent across the treatment plan suggest broader issues with treatment fit. Assent data should inform clinical decisions with the same weight given to skill acquisition and behavior reduction data.
Autistic self-advocates have described ABA experiences characterized by forced compliance, ignored distress, and suppression of autistic behavior patterns. Assent-based practice directly addresses these concerns by requiring that client willingness be monitored and respected, that dissent triggers a response rather than being overridden, and that treatment methods themselves are evaluated for their impact on the client's experience. While assent-based frameworks do not resolve all critiques of ABA, they represent a structural safeguard against the specific harms described and demonstrate the field's capacity to evolve in response to the perspectives of those it serves.
Supervisors are responsible for training supervisees in assent indicator identification, response protocols, and the clinical judgment needed to navigate assent withdrawal situations. They review assent data alongside other clinical data, model assent-responsive practice during observed sessions, and provide guidance on risk-benefit decisions when dissent conflicts with treatment goals. Supervisors who model or tolerate reflexive overriding of client dissent undermine assent-based practice regardless of what the treatment plan specifies. Consistent supervisory messaging that assent monitoring is a non-negotiable component of clinical practice establishes the standard for the entire treatment team.
Evidence and clinical experience suggest that assent-based practice often reduces challenging behavior. Much challenging behavior in treatment contexts functions as escape from aversive demands. When the treatment environment consistently honors dissent expressed through appropriate communication, the motivation for challenging escape behavior diminishes. The individual learns that their refusal will be respected, reducing the need for escalated behavior to achieve escape. Additionally, treatment activities conducted with active assent are more likely to produce engagement, skill acquisition, and positive reinforcement contact, which compete with avoidance-maintained behavior. The result is often a more productive and less conflict-driven therapeutic relationship.
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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.