By Ashleigh Evans, MS, BCBA
Have you ever been in an uncomfortable situation? Were you able to freely leave or voice your concerns and have them respected? Imagine being unable to communicate your discomfort or disagreement with the situation while being forced to stay. That is the reality many autistic children experience in school, therapy, and other areas of their lives. Gaining assent is critical to allow our learners to have a voice in their treatment. Let’s explore what assent is and consider some strategies to establish assent-based care.
Assent Versus Consent: What is the Difference?
First up–what distinguishes assent from consent? Consent is a term that refers to a client (if legally capable) or their parent or legal guardian agreeing to a treatment based on a comprehensive understanding of the intervention’s purpose, benefits, and risks. To provide consent, one must be legally capable of making these decisions. Children (and many adults with special needs) cannot legally provide consent.
Assent, on the other hand, is not a legal term. Assent refers to the client demonstrating signs of agreement or willingness to participate in treatment. Even if they cannot legally approve or deny therapies, every learner can express their preferences and willingness to engage in therapeutic activities.
What is the Significance of Assent?
Acknowledging and respecting assent and assent withdrawal demonstrates an upholding of client dignity, one of the four core principles outlined in the Ethics Code for Behavior Analysts. Gaining client assent in ABA is one component of what many refer to as “Today’s ABA,” a more compassionate approach to behavioral treatment. In the most recent update to the Ethics Code, assent is included as an ethical requirement, under section 2.11. Therefore, behavior analysts should not only understand what assent is but also actively empower their learners through assent-based practices. By doing so, they can create an environment where clients feel safe, valued, and motivated to learn.
What are the Signs of Assent and Assent Withdrawal?
Behavior Technicians and Behavior Analysts should watch for indications of assent and assent withdrawal. Signs of assent may be vocal, such as the learner making affirmative statements (e.g., “I’m having fun!”). They may also be non-vocal, such as eagerly approaching the therapist and actively engaging in activities.
Signs that your learner is providing assent include:
- Smiling and/or laughing
- Cooperating with learning activities
- Making approval statements, such as “I want to keep doing X” and “I love this!”
- Actively engaging in therapy activities
- Eagerly approaching the therapist
- Requesting to repeat activities
- Staying in the therapy space
Assent can be withheld or withdrawn at any time. Assent withdrawal refers to the indications that the learner does not approve of the treatment methods being utilized or goals being targeted. Signs of assent withdrawal may be both vocal, such as protesting (e.g., “no!”) and non-vocal, such as running away.
Signs of assent withdrawal include:
- Turning away or pulling away from learning activities
- Pushing away teaching stimuli
- Eloping from the therapist or therapy space
- Aggression, self-injurious behavior, property destruction, or other harmful behaviors
- Crying, screaming, or vocally protesting
- Dropping or flopping to the floor
- Avoiding the therapist
- Frowning
How Can You Implement Assent-Based Learning in ABA Therapy?
Gaining and maintaining assent is a complex, ongoing process that requires careful observation, flexibility, and respect for the client’s autonomy. Here are a few key strategies you can use to promote assent-based ABA therapy with your learners.
- Prioritize Choices
Empower your learners with choices to foster engagement and promote autonomy. Offer choices in activities, reinforcers, stimuli, location of sessions, and even the structure and order of programs or activities. While the client may not be able to make choices regarding every aspect of therapy, prioritize offering choices whenever possible. - Teach & Reinforce Self-Advocacy
Encourage your learners to communicate their needs, preferences, and boundaries. Regardless of their communication abilities or mode of communication, support them in developing critical self-advocacy skills, such as requesting a break and expressing discomfort.
- Make Therapy Fun
Therapy doesn’t have to feel like work. While there are bound to be goals that are challenging and tasks that aren’t the most preferred, there are countless ways to ensure therapy remains enjoyable and motivating. Regularly conduct preference assessments to ensure you are continuously enriching the environment with preferred items and activities. - Honor Assent Withdrawal
Respect your learner’s right to withdraw assent. This is essential for fostering trust.
- Analyze & Address the Reasons for Assent Withdrawal
When a client withdraws assent, that doesn’t mean the therapy session simply ends or the therapist allows them to do what they want for the remainder of the session. The therapist must analyze the situation to identify the reason(s) for assent withdrawal. They may need to modify various aspects of the learning environment, treatment modality, or goals to regain their learner’s assent. Here are a few things to consider:
- Has the therapist and client successfully paired? Does the therapist continuously focus on maintaining a positive rapport?
- Is the teaching style aversive to the client? (e.g., overly structured and repetitive when the learner may prefer a more naturalistic approach)
- Are the tasks too difficult? Are prerequisite skills missing? Is additional prompting necessary?
- Are the tasks too easy and monotonous?
- Is prompting aversive? (e.g., full physical when the learner does not like to be touched)
- Are there sensory sensitivities that may be making the learner uncomfortable?
- Are the learner’s preferences being accounted for and prioritized?
Beyond Compliance: The Power of Assent
While compliance has historically been a central focus of ABA therapy, the shift toward “today’s ABA” has redefined the field. True progress is about more than simply complying. It’s about trust, active engagement, and meaningful participation. By embracing assent-based practices, behavior analysts can empower their learners to play an active part in their therapeutic journey.
About the Author
Ashleigh Evans, MS, BCBA, is a Board Certified Behavior Analyst. She has been practicing in the behavior analysis field for over 13 years and opened her own independent practice in early 2022. Her experience has been vast across different age groups, diagnoses, and needs. She is passionate about improving the field through education, reformative action, and better supervisory practices, leading her to create content and resources for families and ABA professionals which can be found on her website, www.abaresourcecenter.com