These answers draw in part from “Toward an Understanding of Assent with Individuals with Communication Difficulties” by Cody Morris, Ph.D., BCBA-D, 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 a legal process in which a person with legal authority agrees to treatment or research participation after receiving information about its nature, risks, and benefits. Assent is the individual's own agreement to participate, obtained through a process appropriate to their capacity. For individuals with communication difficulties, assent is particularly important because their guardian provides legal consent but the individual themselves should still be given the opportunity to agree or object through whatever communication modality is available to them.
The critical components typically identified in the literature are voluntariness, meaning the individual is free to participate or not without coercion; information, meaning the individual receives some degree of explanation about what will happen; comprehension, meaning the individual understands the information at some level; and agreement, meaning the individual actively indicates their willingness to participate. For individuals with communication difficulties, each component must be adapted to the individual's repertoire. Full achievement of all components may not be possible, but the practitioner should maximize each to the extent the individual's abilities allow.
Systematic observation is key. Observe the individual across preferred and nonpreferred activities and identify behavioral patterns that reliably differentiate the two. Common indicators of assent include approaching materials or activities, sustained engagement, relaxed body posture, positive vocalizations, and eye contact with materials. Common indicators of dissent include moving away, pushing materials, turning the body away, increased stereotypy, negative vocalizations, and behavioral escalation. These indicators must be defined operationally and validated through consistent observation before being used in an assent protocol.
Pause the current activity and allow the individual to disengage. Offer an alternative activity or a break. After a brief interval, you may re-present the original activity in a modified format to see if the individual is willing to engage under different conditions. If the individual continues to indicate unwillingness, respect that indication and shift to a different activity or conclude the session. Document the withdrawal of assent, the actions you took, and the individual's response. Review the pattern over time to identify whether specific activities consistently trigger assent withdrawal.
Yes. Teaching an individual to communicate agreement and refusal is both a communication development goal and a prerequisite for meaningful assent. Functional communication training can target simple refusal responses such as pushing an item away, using a picture symbol for no, activating a switch, or shaking the head. Teaching these responses and consistently honoring them when they occur builds the individual's repertoire for participating in assent processes. As communication skills develop, the assent protocol should evolve to match the new capabilities.
The treatment plan should include operational definitions of the individual's assent and dissent indicators, the procedure for seeking assent before sessions and activities, the monitoring procedure used during sessions, the response protocol for withdrawal of assent, and any staff training requirements related to the assent protocol. This level of detail ensures consistency across the treatment team and demonstrates that the organization has a systematic approach to respecting the individual's preferences.
Communicate your observations to the guardian clearly, describing the specific behavioral indicators you have observed that suggest the individual objects. Explore modifications that might make the procedure more acceptable to the individual, such as adjusting the format, timing, or context. If the guardian still wishes to proceed, document the guardian's decision, your communication about the individual's response, any modifications attempted, and your ongoing assent monitoring. Continue to monitor and advocate for the individual's preferences while respecting the legal authority of the guardian.
In both contexts, the goal is to respect the individual's right to participate in decisions about their involvement. In research, assent procedures are reviewed and approved by an institutional review board and must be described in the research protocol. The IRB may require specific adaptations for individuals with communication difficulties. In clinical practice, assent procedures are governed by the professional ethics code and organizational policy. Clinical assent is typically more flexible and can be adapted in real time based on the individual's response, while research assent must follow the pre-approved protocol more closely.
The absence of protest should not be automatically interpreted as assent. An individual may not protest because they have learned that protest is ineffective, because they are in a state of compliance due to a history of punishment for refusal, or because they do not yet have the communicative repertoire to express protest. True assent requires active indication of willingness, not merely the absence of objection. The behavior analyst should look for positive indicators of engagement and willingness rather than relying on the absence of negative indicators.
The adaptation should match the individual's current functional communication repertoire. For individuals with fluent verbal communication, standard verbal assent discussions with simplified language may be appropriate. For individuals using augmentative communication systems, present assent information and choices through that system. For individuals communicating primarily through behavior, identify reliable approach-avoidance responses and use those as the basis for the assent procedure. For individuals with very limited behavioral repertoires, maximize monitoring of subtle behavioral changes and establish the most sensitive assent indicators possible. Each level of adaptation should be documented with a rationale.
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Toward an Understanding of Assent with Individuals with Communication Difficulties — Cody Morris · 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.