These answers draw in part from “The Ethics of Assent-Based Practice: Key Features and Where People Go Wrong” by Brigid McCormick, MA, 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 is the formal, legal agreement to receive services, typically provided by a parent or guardian for clients who cannot legally consent for themselves. Assent is the client's own agreement to participate, communicated through whatever means are available to them. The Ethics Code for Behavior Analysts (BACB, 2022) requires behavior analysts to obtain both: consent from the legally authorized party and assent from the client to the extent possible. Assent recognizes that even clients who cannot provide legal consent have the right to communicate their willingness or unwillingness to participate in their treatment.
Developing a functional definition for a non-verbal client requires comprehensive assessment of their behavioral repertoire to identify behaviors that reliably indicate unwillingness to participate. This may include turning away from materials, leaving the area, physical resistance, facial expressions, vocalizations, or changes in engagement level. The key is to identify behaviors that are consistent and contextually appropriate indicators of preference, as validated through systematic observation across multiple situations. These definitions should be developed collaboratively with people who know the client well and should be updated as communication skills develop.
This distinction requires functional assessment. Genuine assent withdrawal and escape-maintained behavior may look identical topographically but differ in the variables controlling them. Analyzing the contexts in which the behavior occurs, such as specific tasks, demand levels, times of day, and setting events, provides data about function. A behavior that occurs exclusively during high-demand activities and is immediately followed by escape suggests a functional relationship with demand avoidance. A behavior that occurs across diverse contexts and appears related to consistent preferences suggests genuine preference communication. Clinical judgment informed by data is essential.
Without functional assessment, practitioners risk two types of errors. First, they may honor all apparent assent withdrawal without analysis, which can result in reinforcing escape-maintained behavior, reducing access to beneficial instruction, and ultimately limiting the client's skill development and independence. Second, they may dismiss all apparent assent withdrawal as escape behavior, which can result in coercive practices that violate client autonomy and damage the therapeutic relationship. Both errors can cause significant harm. Functional assessment provides the data needed to make informed decisions that protect both autonomy and welfare.
Ethical negligence in the name of assent occurs when a practitioner uses assent as a justification for failing to provide needed services. Examples include ceasing all instruction because the client showed any sign of reluctance without assessing the function of that reluctance, not teaching critical safety skills because the client did not appear interested, allowing a client to spend sessions engaged exclusively in preferred activities without any skill building, or failing to address dangerous behaviors because the client resisted intervention. In each case, the practitioner's inaction is framed as respecting autonomy but actually represents a failure to fulfill professional obligations.
Organizations should develop policies that require individualized assent protocols for each client rather than one-size-fits-all rules. Policies should mandate communication assessment as the foundation for assent protocol development, specify that functional assessment is required when patterns of assent withdrawal affect service delivery, provide training and supervision resources for all staff implementing assent protocols, and create consultation mechanisms for complex assent-related decisions. Policies should avoid rigid rules such as always stop or never stop and instead support analytical, data-informed clinical judgment.
Assent-based practice and the neurodiversity movement share a commitment to respecting the autonomy and self-determination of individuals with disabilities. Both challenge practices that prioritize compliance and conformity over client welfare and dignity. However, assent-based practice within behavior analysis adds the analytical framework of functional assessment, which distinguishes it from approaches that simply defer to all expressed preferences without analysis. When implemented thoughtfully, assent-based practice aligns with neurodiversity values while maintaining the behavior analyst's clinical responsibility to ensure effective and beneficial services.
Caregivers provide essential information about their family member's communication patterns, preferences, and history. They should be involved in developing functional definitions of assent and assent withdrawal, and their observations across settings should inform the ongoing assessment of assent-related behaviors. When clinical decisions about assent are complex, such as when honoring assent withdrawal would mean foregoing instruction in a critical skill, caregivers should be part of the discussion and decision-making process. However, the behavior analyst retains professional responsibility for ensuring that clinical decisions are informed by behavioral assessment.
Assent protocols should be reviewed at minimum during each treatment plan update cycle, but more frequent review is appropriate when the client's communication repertoire is developing rapidly, when new patterns of assent-related behavior emerge, or when the treatment program undergoes significant changes. Any time a team member observes that the current definitions of assent giving or withdrawal do not seem to accurately capture the client's communication, a review should be initiated. Regular review ensures that the protocol remains accurate and that team members are implementing it consistently.
Yes, and it should. Assent-based practice does not mean that challenging behaviors are never addressed. It means that interventions for challenging behavior are developed with attention to the client's autonomy and dignity, that the client's communication about their experience of the intervention is monitored and respected, and that the least restrictive effective intervention is used. Functional assessment of both the challenging behavior and assent-related behaviors informs how to intervene in ways that address the behavior while honoring the client's right to communicate their preferences about their treatment.
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The Ethics of Assent-Based Practice: Key Features and Where People Go Wrong — Brigid McCormick · 3 BACB Ethics CEUs · $50
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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.