By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
Consent is a legal process by which a guardian or authorized representative agrees to the provision of treatment after being informed about the nature, risks, and benefits of the proposed services. Assent refers to the agreement of the individual receiving services, expressed through their behavior, regardless of whether they have the legal capacity to provide formal consent. A parent may consent to ABA services for their child, but the child's willingness to participate in those services, moment to moment, constitutes assent. Both are ethically important, but assent addresses the lived experience of the person receiving treatment.
No. This is the most common misconception about assent-based practice. Assent-based practice means systematically monitoring the client's willingness to participate, responding thoughtfully when dissent is observed, and making decisions about whether to continue, modify, or pause activities based on clinical judgment and the client's welfare. There are situations where continuing despite reluctance is clinically appropriate, such as safety-related activities. The key difference is that these decisions are made deliberately, documented with rationale, and subject to ongoing evaluation rather than being made reflexively or without attention to the client's experience.
Careful observation and collaboration with people who know the client well are essential. Assent indicators for nonverbal clients may include approach behavior, reaching for materials, eye contact, relaxed posture, positive vocalizations, and physical engagement with activities. Dissent indicators may include avoidance, pushing materials away, turning away, increased stereotypy or self-stimulation, crying, aggression, self-injury, and attempts to leave. These indicators should be operationally defined for each individual client, documented in the treatment plan, and refined over time as the team learns more about the client's communication repertoire.
Safety-related interventions present a particular challenge for assent-based practice because the consequences of not intervening may be severe. When a client's safety is at immediate risk, the behavior analyst may need to implement protective interventions even in the absence of client assent. However, even in safety-related situations, assent-based principles apply. The response should use the least restrictive effective intervention, should be time-limited, and should be followed by efforts to restore the client's choice and autonomy as quickly as possible. The decision to override assent for safety should be documented with clear rationale.
This tension is common and requires skilled navigation. Begin by educating caregivers about the rationale for assent-based practice, including the evidence that client engagement and willingness predict better outcomes. Help caregivers understand that treatment delivered over client resistance may produce short-term compliance but can damage the therapeutic relationship and reduce long-term effectiveness. Collaborate with caregivers to find approaches that meet their goals while respecting the client's autonomy. Document the discussion and the rationale for the approach adopted. Code 3.01 establishes that the client's welfare is the primary consideration.
Several data collection methods can be used. Momentary time sampling of engagement and affect provides a snapshot of assent across the session. Event recording of dissent indicators captures specific instances of refusal or avoidance. Duration recording of active engagement measures the proportion of the session during which the client is willingly participating. Rating scales completed by the therapist at the end of each session can capture global impressions of client willingness. Choose the method that is most practical for your setting and that captures the most clinically relevant information for each client.
Common myths include: that assent-based practice means the client controls all aspects of treatment, that it eliminates the use of any demand-based instruction, that it is incompatible with skill acquisition programming, that it requires abandoning evidence-based procedures, and that it only applies to verbal clients. In reality, assent-based practice is about respecting client autonomy within a framework of competent clinical judgment. It is compatible with structured teaching, skill acquisition, and evidence-based intervention. It applies to all clients, including those who communicate through behavior rather than words.
The neurodiversity movement has been a significant catalyst for assent-based practice in behavior analysis. Autistic self-advocates have described experiences of ABA treatment in which their preferences and comfort were overridden in pursuit of behavioral compliance. These accounts have prompted the field to examine its practices and develop approaches that honor client autonomy and dignity. Assent-based practice aligns with neurodiversity principles by recognizing that the client's experience of treatment matters and that effective services must respect the individual's right to participate willingly.
Yes, though it requires adaptation. In group settings, behavior analysts can build choice into the structure of activities, provide options for how students participate, establish clear indicators that allow individuals to signal when they need a break, and create environmental arrangements that promote willing engagement. The principles are the same as in individual settings: monitor assent, respond to dissent thoughtfully, and design environments that maximize the likelihood of willing participation. Group norms can be established collaboratively, giving participants ownership over the expectations.
RBTs should be trained to recognize each client's individualized assent and dissent indicators, to follow the response protocols established in the treatment plan when dissent is observed, to collect data on assent-related variables, and to communicate with their supervisor when assent-related challenges arise. Training should include role-play scenarios that practice responding to different types of dissent in different contexts. RBTs should understand the rationale for assent-based practice and how it aligns with the Ethics Code. Ongoing supervision should include feedback on assent-related clinical decisions.
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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.