ABA Inside Track: Episode 331 – Operationalizing Assent

Date: December 24, 2025
Hosts: Robert (Rob) Perry Crews, Diana Perry Crews, Jackie McDonald

Episode Overview

This episode of ABA Inside Track delves into the critical but complex topic of “operationalizing assent” in behavior analytic research and practice. The hosts explore the ethical, procedural, and practical challenges of obtaining and honoring assent, especially among populations that may have communication challenges or diminished capacity for consent. Drawing from new research and comparisons across human services fields, they discuss both the need for clearer guidelines and actionable strategies for practitioners and researchers.

Key Discussion Points & Insights

1. Defining Consent vs. Assent (08:57, 09:57)

• Consent: A formal, informed agreement to participate in services or research, provided by those legally able to do so.

  • Involves clear communication about the goals, procedures, risks, rights, confidentiality, incentives, and ways to ask questions.
  • BACB Definition Used: Informed consent comprises ensuring understanding about participation, right to withdraw, risks/benefits, confidentiality, incentives, and contact info (09:57).

• Assent: An individual’s vocal or non-vocal indication of willingness to participate, especially when they can't provide legal consent (e.g., minors, those with intellectual disabilities).

  • Often involves interpreting behaviors or indirect indicators (e.g., body language, willingness to enter a setting).

• Notable quote:
  "Assent is vocal or non vocal behavior that can be taken to indicate willingness to participate in research or behavioral services by individuals who cannot provide informed consent because of their age... or intellectual impairment." – Jackie (09:57)

2. Why Is Operationalizing Assent Important? (11:59, 39:45)

• Ethical Imperative: Past research abuses demonstrated the need for respecting participant autonomy (e.g., Little Albert, Milgram experiments).

• The Belmont Report and subsequent institutional safeguards arose to prevent harm, mandate IRB reviews, and stress participant dignity.

• "There have been many and numerous research studies that have violated the autonomy, dignity, and integrity of individuals that were under the surmise of research." – Jackie (11:59)

• Practice Complexity:

  • While consent is formal and institutionalized, assent, especially with vulnerable or nonverbal participants, is less regulated and more interpreted.
  • The process can vary widely depending on the IRB’s standards, settings, and individual practitioner judgment.

3. Surveying the State of Assent in ABA (20:11, 21:39)

• Research Gaps & Survey Data:

  • Morris et al. (2021): Less than 1% of over 23,000 reviewed ABA research articles explicitly mentioned assent procedures.
  • Mead et al. (2025): Surveyed 123 BCBA researchers.
    • 84% felt highly confident about their consent procedures; only ~60% felt the same for assent.
    • Consent typically managed with clear, standard procedures; assent is more variable, using a mix of vocal requests, nonverbal cues, or written forms.
    • Only 47% felt their assent procedures truly conveyed risks/benefits to participants.
    • Practices for obtaining and reporting assent are inconsistent and often driven more by personal/team experience than by field-wide standards.

• Common Barriers:

  • Lack of published best practices.
  • Ascent procedures are less often required by IRBs.
  • Difficulty distinguishing between genuine assent and compliant behavior — especially in dual-role clinician-researcher settings.

• Notable quote:
  "I think in our field, too, we have to be especially careful because when we are doing research, we're not always just researchers. We're also the clinicians of the participants. Right. So there's that dual relationship at play. So we have to figure out where the fine line is between research and clinical work..." – Jackie (19:31)

• Diversity of Approach:

  • Some practitioners seek assent before every session, some continuously monitor for assent/dissent, others do it once, or not at all.

4. Assent Across Professional Fields (39:45, 45:59)

• Flowers & Dawes (2023) compared guidelines for assent in behavior analysis (BACB), psychology (APA), and school psychology (NASP).

  • All require practitioners to seek assent but differ in mandated elements and specificity.
  • NASP stands out for detailed guidelines:
    • Encourages explanation of services, honoring withdrawal, client involvement in planning, consideration of legal requirements, and minimizing overwhelming choices.

• Key Chart Summary (45:59):

  • BACB uniquely references nonvocal assent and IRB guidelines.
  • Only APA requires documentation of assent.

5. Strategies for Operationalizing Assent (48:44, 54:46)

• Teaching Dissent & Communication:

  • Ensuring clients can indicate “no” and providing alternate means for non-vocal communication (e.g., sign language, picture selection).

• Concurrent Chains Procedures:

  • A systematic method for assessing and honoring preference, especially for those with limited communication.

• Ongoing Social Validity Assessments:

  • Continuously confirming willingness via measures like attendance, observable affect, engagement, and feedback from both the client and caregivers.

• Adapting to Population & Context:

  • Recognizing that assent indicators and best practices must be customized to client skills and settings.

• Notable moment:
  "If your client is attempting to escape from all of your therapy sessions or indicates what appears to be dissent in all of your therapy sessions, let's revisit what your therapy sessions look like. Maybe they are overall aversive..." – Diana (49:26)

Notable Quotes & Memorable Moments

• On Consent vs. Assent:
  • "Consent... involves communicating about and taking appropriate steps to confirm understanding... assent is vocal or non vocal behavior that can be taken to indicate willingness to participate..." – Jackie (09:57)
• On Assent Challenges:
  • "Are the participants actually giving assent or is it a history of reinforcement with compliant behavior?" – Jackie (20:09)
• On Cross-Field Perspectives:
  • "Looking at the NASP requirements... broadens our field's idea... Just thinking about ascent as more than just looking for signs of 'they're coming into the experiment room.'" – Rob (47:38)
• On Institutional Limitations:
  • "It's just leaving it up to the clinicians or the researchers... requiring that the BCBAs make those decisions individually." – Diana (16:48)
• Pasta & Parmesan Analogy:
  • The hosts humorously compare assent to the "Olive Garden cheese grater" experience, where the client can indicate, "tell me when," illustrating flexible, ongoing opportunities for assent (62:32).
• On Future Guidance:
  • "The more that we can establish some guidelines, I think the better. So we're on the right track." – Diana (60:27)

Timestamps for Major Segments

• 01:12–03:01: Introduction to the episode’s theme; real-world value of assent in clinical and research contexts.
• 09:57–11:59: Precise definitions from BACB Ethics Code; clarification of consent and assent.
• 12:31–14:16: Historical context and ethical mandates (Little Albert, Milgram, Belmont Report).
• 16:14–17:53: Institutional Review Board (IRB) practices; when assent is required or waived.
• 20:11–21:39: Discussion of prior research by Morris et al. (2021) on how rarely assent is addressed in ABA literature.
• 21:39–29:06: Mead et al. (2025) survey results; practitioners' reported experiences and challenges with consent/assent.
• 45:59–48:44: Summary of cross-disciplinary guidelines for assent and their implications for ABA.
• 48:44–55:35: Practical strategies for teaching, observing, and honoring assent/dissent, especially for nonverbal clients.
• 62:32–63:12: Memorable "pasta/cheese grater" metaphor for ongoing, customized assent.

Conclusions & Next Steps

• Clear Need for Guidance:
  The field lacks robust, standardized guidelines for operationalizing assent—a gap that introduces variability and risk of ethical lapses.

• Recommendations & Call to Action:

  • Increase training and dialogue on operationalizing and documenting assent.
  • Share and publish innovative practices for measuring and honoring assent, especially for clients with communication differences.
  • Look across related fields for guidance and adapt effective guidelines.

• Research Needs:

  • More empirical work on how assent can be identified, taught, and maintained across different populations.
  • Development of user-friendly tools (e.g., flowcharts, resources) for practitioners.

Further Listening (Pairings Section, 61:15)

• Related Podcast Episodes:
  • Ep. 236: Assent and Self-Determination
  • Ep. 251: Self-Determination and IEP Planning
  • Ep. 204: Trauma-Informed ABA
  • Ep. 290: Skill-Based Treatment
  • Ep. 231: Enhanced Choice Model
  • Ep. 276: Concurrent Chains
  • Ep. 270: Social Validity Assessments

Takeaway

Operationalizing assent is not just a compliance checkbox but a continuing, ethically vital process—especially for vulnerable populations. ABA as a field must invest in training, research, collaboration, and policy development to better honor client autonomy and dignity.