The Importance of Assent in ABA Therapy

Hannah Andreasen, MSEd, BCBA

Hannah is a Board Certified Behavior Analyst and TherapyWorks Clinical Director. She has more than 10 years experience working in the field of ABA.

January 3, 2024

ABA (Applied Behavior Analysis) is a widely recognized therapy that can effectively improve/teach new behaviors and reduce undesired behaviors in children with Autism and other developmental disabilities.

When parents start their child in therapy such as ABA, they provide informed consent for services, often through signing a form. But there’s another term, known as assent, that is also critical. An ethical and effective ABA therapy plan should be centered around the concept of assent.

Assent in ABA occurs when the child demonstrates an understanding of what is happening and agrees (verbally or nonverbally) to participate. This person-centered model of ABA focuses on the well-being of the child.

Let’s explore why assent in ABA is important, and how it can lead to improved outcomes in therapy through building trust and enhancing collaboration.

What is Assent in ABA?

Assent in ABA refers to the voluntary cooperation or agreement of the individual who is receiving therapy.

Assent differs from consent. Consent occurs when the parent or guardian of the child receiving services is informed about the services that will be provided and legally agrees to them.

Assent occurs when the child (who is not able to provide legal consent) shows that he or she voluntarily agrees to participate in therapy. Assent withdrawal occurs when the child shows signs that they do not agree or want to participate in therapy.

Making assent a priority in ABA therapy shows respect for each child’s autonomy. It acknowledges the child’s right to be informed and choose to participate in therapy.

Signs of Assent and Assent Withdrawal

Children can show assent and assent withdrawal verbally or nonverbally. Signs of assent include: saying yes, smiling, actively engaging in activities, and interacting with the therapist.

Signs of assent withdrawal include saying “no”, showing refusals to participate, and avoiding or demonstrating a negative attitude towards interacting with the ABA therapist.

In order to see signs of assent and assent withdrawal, the ABA therapist must be observant, actively listening and watching for signs of communication from the child.

The Importance of Recognizing Assent

The Ethics Code for Behavior Analysts from the Behavior Analyst Certification Board (BACB) states that obtaining assent from clients is a responsibility of behavior analysts. The BACB board defines assent as:

“Vocal or nonvocal behavior that can be taken to indicate willingness to participate in research or behavioral services by individuals who cannot provide informed consent (e.g., because of age or intellectual impairments).”

Building trust through communication. Assent promotes a safe environment where the child feels comfortable expressing their preferences and needs. Therapists can adapt strategies to fit the communication styles/needs of the child, which may include verbal and nonverbal methods.

Promoting autonomy. Recognizing the child’s autonomy can contribute to their overall wellbeing and development.

Enhancing individualized care. Making assent a priority emphasizes the importance of involving the child’s unique interests and needs in the therapy process. The ABA therapist can tailor treatment goals and approaches to align with the child’s strengths, needs, and preferences.

Supporting ongoing monitoring. The ABA therapists can consider the child’s signs of assent and assent withdrawal to continuously monitor and adjust interventions.

The child’s feedback, response to intervention strategies, and participation in specific activities allows the therapist to make changes to their treatment methodologies as indicated. This can create a more effective, appropriate intervention approach.

Increased caregiver involvement. As with other therapies, such as Speech Therapy and Occupational Therapy, caregiver involvement is a critical aspect of effective ABA therapy.

Making assent a priority in therapy encourages the therapist to communicate with parents and caregivers about the therapy process and the significance of assent. This education and communication creates a collaborative partnership between the family and ABA therapist.

Research shows that parent involvement leads to positive outcomes in academic and social behaviors. Ongoing collaboration and communication encourages home carryover of strategies, enhancing the effectiveness of ABA intervention.

Challenges & Considerations

Assent is a fundamental aspect of ethical ABA treatment, though there are some unique challenges in obtaining and maintaining assent that therapists and parents should keep in mind.

Many children who receive ABA therapy have communication challenges. Some children may be nonverbal or may not consistently or clearly indicate their needs or preferences with others.

ABA therapists and parents can navigate communication challenges by taking the child’s unique communication style into consideration. They can also collaborate with other professionals working with the child, such as the Speech-Language Pathologist. This can help them identify the child’s signs of assent and assent withdrawal in ABA sessions.

Incorporating tools such as AAC (Augmentative and Alternative Communication) and using visual supports provides the child with multiple methods of communication.

Behavioral difficulties can also present challenges in obtaining assent in ABA. Creating a sensory-friendly environment that reflects the child’s needs and interests can increase his or her level of comfort and cooperation.

Additional Resources

ABA can effectively improve behaviors in a child with autism or developmental delays. Parents provide informed consent to agree for the child to participate in therapy, and it is just as important for the child themself to communicate the willingness and desire to participate.

Obtaining assent in ABA therapy is not only ethical, but it helps foster a positive relationship between the therapist and the child/family, enhances clear communication, and prioritizes the unique needs and preferences of the child. This can all lead to positive, effective ABA intervention.

TherapyWorks offers speech therapy, occupational therapy, physical therapy, and ABA therapy in person (in Illinois, Michigan, and Ohio) and through teletherapy (nationwide). Therapists prioritize assent in all of the therapy services we provide, including ABA therapy. Our team of specialists are experts in working with children on the Autism spectrum and those with developmental delays.

If you would like to learn more or discuss your child’s specific needs, please don’t hesitate to reach out to TherapyWorks!

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