These answers draw in part from “Clinical Informed Consent and ABA” (Special Learning), 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 simply agreement or authorization to proceed with a proposed action. Informed consent adds the requirement that the agreement be based on adequate information and genuine understanding. A client who signs a consent form without understanding what they are agreeing to has provided consent but not informed consent. Legal standards require that the individual giving consent receive material information about the nature of the proposed treatment, its risks and benefits, available alternatives, and the consequences of declining treatment. The information must be presented in a manner the individual can understand, and the decision to consent must be voluntary, free from coercion or undue pressure.
At minimum, informed consent for ABA services should include a description of the proposed assessment and treatment procedures, the expected benefits and potential risks of treatment, available alternative approaches and their relative advantages and disadvantages, the qualifications of the practitioners who will deliver services, the expected duration and intensity of services, data collection and privacy practices, costs and billing arrangements, the right to decline or withdraw consent at any time, and the process for raising concerns or filing complaints. Code 2.11 of the BACB Ethics Code provides additional guidance on required elements. The specific case law in your jurisdiction may impose additional requirements.
Informed consent requires comprehension, which means information must be provided in a language and manner the individual can understand. When working with families who speak a different language, use qualified interpreters rather than family members, as family members may not have the technical vocabulary needed and may filter information based on their own understanding. Provide written consent documents in the family's primary language. Verify comprehension through the interpreter by asking the family to explain key concepts in their own words. Document the language accommodations provided. If qualified interpretation is not available, this represents a barrier to obtaining valid informed consent that must be addressed before proceeding with services.
Consent should be renewed or updated whenever there is a material change in the treatment being provided. This includes the introduction of new procedures not covered by the original consent, significant changes in treatment goals or priorities, changes in the intensity or duration of services, new information about risks or alternatives that was not available at the time of original consent, changes in the practitioners delivering services, and changes in costs or billing arrangements. Additionally, consent should be reviewed periodically even when no specific changes have occurred, to ensure that the family remains informed and continues to authorize the current approach. Document each consent update in the clinical record.
The professional standard, also called the physician standard, requires practitioners to disclose what a reasonable practitioner in the same specialty would disclose under similar circumstances. It is defined by professional custom and practice. The patient-centered standard, also called the reasonable patient standard, requires disclosure of information that a reasonable patient would consider material to their treatment decision. The patient-centered standard is generally more protective of client rights because it focuses on what the client needs to know rather than what the practitioner customarily tells. Different states have adopted different standards, so behavior analysts should be aware of which standard applies in their jurisdiction. When in doubt, the patient-centered standard provides a useful guide because it encourages more comprehensive disclosure.
When the client is a minor or an individual who cannot provide informed consent independently due to cognitive limitations, consent must be obtained from a legally authorized representative, typically a parent, legal guardian, or appointed decision-maker. However, best practice extends beyond obtaining representative consent. To the greatest extent possible, the client themselves should receive age-appropriate and ability-appropriate information about their treatment and should have the opportunity to express their preferences. This process, often called assent, acknowledges the client's autonomy even when they cannot provide legal consent. If the client actively objects to a proposed procedure, this objection should be given serious consideration, documented, and discussed with the authorized representative.
Treatment provided without adequate informed consent can give rise to legal liability under two theories. The first is battery, which applies when treatment is provided without any consent at all. Battery requires no showing of harm; the unauthorized touching itself constitutes the violation. The second is negligence, which applies when consent was obtained but was not adequately informed. A negligence claim typically requires showing that the practitioner failed to disclose material information that a reasonable person would have wanted to know, and that if the information had been disclosed, the person would not have consented to the treatment. The specific legal standards and potential consequences vary by jurisdiction, making it important for practitioners to understand the law in their state.
Documentation should go beyond the signed consent form to include a narrative note about the consent conversation. This note should describe the information presented to the client or family, the questions they asked and the answers provided, any concerns raised and how they were addressed, evidence that comprehension was verified, and the decision made. When consent is updated due to treatment changes, document the specific changes discussed, the additional information provided, and the family's response. If a family declines a recommended procedure, document the recommendation, the information provided about risks and benefits of the recommended and alternative approaches, and the family's decision. This comprehensive documentation provides the strongest evidence of a thorough consent process.
Yes. The right to withdraw consent is a fundamental component of the informed consent doctrine. Clients and their authorized representatives have the right to discontinue treatment at any time for any reason. This right should be communicated clearly during the initial consent process and respected if exercised. When a client or family withdraws consent, the practitioner should discuss their concerns, provide information about the potential consequences of discontinuing treatment, offer to modify the approach to address their concerns if appropriate, and facilitate a responsible transition to alternative services if they decide to proceed with withdrawal. Code 2.15 provides guidance on the practitioner's responsibilities when services are terminated.
Informed consent applies to assessment procedures just as it applies to treatment procedures. Before conducting a functional behavior assessment or any other assessment, the practitioner should explain the purpose of the assessment, the procedures that will be used including observation, interview, and any experimental conditions, the time involved, any risks or discomforts associated with the assessment procedures, how the results will be used, and who will have access to the assessment report. If the assessment involves functional analysis conditions that may temporarily increase challenging behavior, this risk must be disclosed. The family should have the opportunity to ask questions, express concerns, and give or withhold consent before the assessment begins.
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279 research articles with practitioner takeaways
195 research articles with practitioner takeaways
194 research articles with practitioner takeaways
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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.