These answers draw in part from “Creating A Culture of Consent: Translating Assent/Consent Research Into Functional Treatment Goals and Daily Practice” by Leigha Sochurek, M.Ed, BCBA, LBA (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 refers to informed agreement provided by an individual who has the legal capacity and cognitive ability to understand what they are agreeing to. In ABA services, legal consent is typically provided by a parent or guardian. Assent refers to the client's own expressed or behavioral agreement to participate in an activity, even when they may not meet the threshold for legal consent. Both are ethically important. Consent ensures that services are authorized by a responsible party, while assent ensures that the client themselves is a willing participant in their own treatment.
For nonverbal clients, assent and withdrawal of assent must be identified through observable behavioral indicators. Assent behaviors might include approaching the instructional area, reaching for materials, maintaining proximity to the practitioner, and displaying relaxed body posture. Withdrawal of assent might be indicated by moving away from the instructional area, pushing materials away, turning away from the practitioner, increased motor activity or emotional distress, or engaging in behaviors that have historically functioned as escape responses. These indicators should be individualized for each client and documented in the treatment plan.
No. Honoring client refusal means pausing the current approach, assessing what the client is communicating, and finding alternative ways to work toward the same therapeutic goals. It may mean modifying the task, changing the instructional context, adjusting the motivating operation, or approaching the same skill through a different entry point. The goal remains the same. The method adapts to respect the client's autonomy. Research consistently shows that instruction delivered within the context of client willingness produces better generalization and maintenance than instruction delivered through compliance.
A consent-based approach requires careful examination of prompting strategies, particularly physical prompting, through the lens of client autonomy. Physical prompts that involve moving the client's body should be used only when the client demonstrates willingness to receive physical guidance. Practitioners should develop and prioritize less intrusive prompting strategies, such as modeling, gestural prompts, visual supports, and environmental arrangement. When physical prompting is necessary, it should be preceded by a clear signal and opportunity for the client to refuse, and the client's behavioral response should be monitored continuously.
From a behavior analytic perspective, consent requires several conditions: the individual must have access to relevant information about what they are consenting to, presented in a form they can understand. They must have a functional response in their repertoire for expressing agreement or refusal. The response must be emitted in the absence of coercive contingencies that would invalidate it. And the consent must be ongoing, meaning the individual retains the ability to withdraw consent at any point. Each of these conditions can be assessed and, when deficient, targeted for skill development.
This situation requires empathetic, informed communication with the caregiver. Begin by validating their concerns about their child's progress. Explain the rationale for consent-based approaches using evidence and examples, including how they often produce better long-term outcomes. Discuss the risks associated with compliance-based approaches, such as the suppression of functional communication and potential vulnerability to exploitation. Collaborate with the caregiver to identify a gradual transition plan that addresses their concerns while moving toward consent-based practice. Document these discussions per Code 3.05.
Multiple provisions of the Ethics Code (2022) support consent-based practice. Code 2.11 (Obtaining Informed Consent) addresses the formal consent process. Code 2.01 (Providing Effective Treatment) supports consent-based practice because willing participation enhances treatment outcomes. Code 2.15 (Minimizing Risk) aligns with the preference for less intrusive approaches that consent-based practice promotes. Code 2.09 (Involving Clients and Stakeholders) requires client involvement in service decisions. Together, these provisions create a strong ethical foundation for consent-based practice.
Yes, and teaching consent-related skills should be a priority intervention target. These skills include expressing preferences between options, communicating agreement and refusal in functional ways, requesting modifications to activities, asking for breaks, reporting discomfort or distress, and understanding the relationship between their communication and others' responses. These skills serve the dual function of enhancing the client's participation in treatment and developing self-advocacy abilities that have lifelong significance for personal safety and self-determination.
Withdrawal of assent manifests differently across activity types. During discrete trial instruction, it might appear as turning away from materials, not responding to task presentations, or leaving the instructional area. During natural environment teaching, it might involve moving to a different area, engaging with a different activity, or displaying signs of agitation. During social skills groups, it might present as withdrawing from the group, refusing to participate in activities, or seeking to leave the room. Practitioners must be attuned to these context-specific indicators and respond by pausing the activity and assessing the client's communication.
Safety concerns do not negate the importance of consent-based practice, but they do require thoughtful prioritization. When a client's behavior poses immediate safety risks, the practitioner's responsibility to ensure safety takes precedence. However, even in these situations, consent-based principles should inform the approach. This means using the least restrictive safety measures available, working actively to develop the client's communication repertoire so they can participate in safety planning, and continuously evaluating whether less restrictive alternatives can replace more restrictive ones as the client develops new skills.
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Creating A Culture of Consent: Translating Assent/Consent Research Into Functional Treatment Goals and Daily Practice — Leigha Sochurek · 2 BACB Ethics CEUs · $20
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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.