Assent and Assent Withdrawal: Definitions and Applications
Assent-based practices have gained significant attention in recent years. Some professionals have even coined the term “Compassionate ABA,” which has led others outside of the field to question whether ABA is, in fact, compassionate. Over the past few years, ABA researchers and practitioners have worked diligently to define what assent is and its role in ABA therapy. This ongoing effort has led to multiple interpretations of how assent is expressed, agreed upon, and withdrawn in the context of treatment.
First and foremost, practitioners can refer to the BACB’s Code of Ethics, which states that BCBAs should “act in the best interest of clients.” However, the Code does not offer a concrete definition of what “best interest” looks like for each individual client, nor does it provide a universal standard for determining when it’s being met. Given the absence of a single, universally accepted definition, professionals rely on a combination of the Code of Ethics, governing laws, and previous research to shape their understanding of assent in practice.
At its core, assent-based treatment in ABA involves the delivery of services in which the client agrees to engage and participate actively in the intervention. Assent withdrawal occurs when the client signals their refusal or nonagreement to participate in the treatment. It is important to note that assent and assent withdrawal may look different across clients. Recognizing when assent is given and withdrawn depends entirely on the individual learner, as each person may express their agreement or disagreement in unique ways.
How to Identify Assent and Assent Withdrawal
There are various ways to identify assent and assent withdrawal, including simple observation and interviews with family members, friends, or the client themselves. By presenting items that the client either enjoys or dislikes, we can observe their behavior and determine how they express agreement or disagreement.
Signs of assent may include behaviors like reaching toward the therapist, smiling, or making eye contact. Withdrawal of assent could be observed as pulling away, crying, or hiding the face. However, these behaviors can vary greatly depending on the learner. It is crucial to observe each client individually to understand how they communicate their feelings about participating in treatment.
How Can We Teach Assent?
By understanding what assent looks like for each learner, we can begin teaching both assent and assent withdrawal by modeling functional communication. One approach is to observe when a learner shows signs of assent and then pair those behaviors with language. For instance, we might say, "Yes! I like this!" or "This is scary, but I'm trying it" when the learner is engaging with the activity.
Similarly, when withdrawal of assent occurs, we can use functional communication to help the learner express themselves. Phrases like "I don't like this," "I'm not okay with this," "I'm all done," or "I need a break" can help the learner communicate their needs and boundaries.
What Happens When Our Learner Withdraws Assent?
When a learner withdraws assent during a task, it doesn’t mean they’re avoiding work. Instead, it signals that the learner isn’t ready for the task at that particular moment. There are three primary ways to respond when a client withdraws assent:
Don’t Re-present the demand: Honor the withdrawal and provide functional language to acknowledge the learner’s challenge. This lets the learner know that their feelings are respected.
Re-present the demand at a Later Time: Honor the withdrawal, but try again later. This gives time to consider possible reasons for withdrawal (e.g., environment, noise, hunger) and make adjustments when reintroducing the task.
Present the demand with Accommodations: Present the task again, but with adjustments to make it more manageable for the learner. This could involve altering the environment or using different strategies to make the task easier.
Example: Imagine John’s mom tells him it’s time to change clothes and leads him to the bathroom. John begins to scream and falls to the floor, refusing. Now let’s respond using our three options. If we decide not to re-present, we may allow John to stay in his pajamas, honoring his withdrawal of assent.
If John’s shirt becomes wet from water play, we might choose to re-present the task of changing clothes later. We could say, “I see you don’t want to change right now. How about we try again in a little bit?” When re-presenting, we could adjust the approach by showing him clothing options, presenting a picture of the shirt, or offering the option to change in a different space, like his room.
In another scenario, if John has had a bowel movement accident, it’s important to present the task of changing clothes immediately with accommodations, such as offering a wagon ride to the bathroom, playing music for a smoother transition, offering choice of clothes to change into or making the process more fun by marching to a song like “The Ants Go Marching.”
In Our Practice
In our practice, we focus on teaching our clients how to give assent to therapy and how to withdraw it when they feel uncomfortable. While it’s necessary to sometimes encourage clients to face things that may initially cause discomfort, it’s essential that we, as practitioners, caregivers, and trusted adults, provide the necessary support when they withdraw assent. This helps our clients learn to advocate for themselves, not just during therapy but throughout all aspects of their lives.
At One of the Kids, we proudly implement assent-based treatment to empower our clients to communicate their needs, preferences, and boundaries effectively.
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