Assent in ABA: what happens when a child says no?

What does it mean when a child says “no” in ABA?

Informed consent comes from you, the parent. Assent comes from your child, in whatever way they can give it. A child can agree to start and then change their mind, and we treat that change as real. A “no” is the start of a conversation, not a behavior to override.

Here is the profession's own definition, from the glossary of the ethics code every BCBA is bound by:

Outside source, not affiliated with Budding Futures

Vocal or nonvocal verbal 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).

Two researchers who wrote a practical guide to assent add the part parents care about most. In their words, "assent is the agreement to participate by an individual who is unable to legally consent that can be revoked or withdrawn at any time (i.e. assent withdrawal or dissent)" (Breaux and Smith, 2023). So a child can withdraw assent, with words or without them, and the adult is supposed to notice.

How does a child tell us “no”?

Not every child can say the word. We watch for it in a lot of ways, and we watch for the opposite too. The signs of assent show a child is on board; assent withdrawal shows they want to stop.

This matters most for children who do not speak. Breaux and Smith are direct about it: "a learner's verbal skills (or lack thereof) should not determine whether they can assent." Their paper lists spoken and unspoken ways of agreeing and of withdrawing, much like the table above (International Journal of Developmental Disabilities).

One practical step is to teach a clear way to say no. Functional communication training teaches a child a reliable way to ask for a break or to stop, by word, sign, picture or device. That gives a child who cannot speak a way to withdraw their assent that every adult will recognize.

What does our therapist do when a child withdraws assent?

1. Pause and notice it.
2. Honor it, rather than pushing through.
3. Make the task easier, or take a break.
4. Add something motivating and reconnect.
5. Try again later, in a way that works better.

We do not power through a meltdown just to finish a task. Forcing it teaches your child that saying “no” does not matter, which is the opposite of what we want.

Distress, avoidance, or just a hard moment? How we tell the difference

This is the honest, hard part. Not every “I don’t want to” means stop forever. A child avoiding something new is different from a child in real distress, and we do not treat every bit of avoidance as a hard no. We read the whole picture: mood, body, and what we know about your child. When there is real distress, we stop and regroup. When it is a new-and-unsure moment, we make it smaller and safer and try with more support.

When can't a child opt out? Safety

Some things are not optional, like keeping a child from running into a street or hurting themselves. Safety comes first, and we are honest about that. Outside of safety, we work with your child’s “no,” not around it.

Who decides the goals?

Goals are chosen with you and your child, and they aim at quality of life and communication, not at making your child look “normal.” The ethics code puts it this way: "Behavior analysts make appropriate efforts to involve clients and relevant stakeholders throughout the service relationship, including selecting goals, selecting and designing assessments and behavior-change interventions, and conducting continual progress monitoring" (BACB Ethics Code, standard 2.09). If a goal does not matter to your family’s real life, it does not belong on the plan.

What good ABA does NOT do

• No forced physical compliance to win a task.
• No punishing or “fixing” harmless stimming or eye contact.
• No aversives, ever.
• No goal aimed only at masking who your child is.

If a provider does these things, treat it as a red flag and ask questions.

Why do some autistic adults criticize ABA, and how is modern practice different?

The Autistic Self Advocacy Network (ASAN) is run by autistic people, and it is critical of ABA as a whole, past and present. Parents should read that in ASAN's own words, not ours. From its paper For Whose Benefit?:

Outside voice, critical of ABA, not affiliated with Budding Futures

If we cannot give informed consent to a given service (for example, an autistic child who cannot legally consent), we still must be given the chance to give or refuse assent.

ASAN's sharpest point is about what a child learns from being overruled. It describes interventions that "portray the mere act of saying no as 'non-compliance' and teach the autistic person that their right to say 'no' does not exist." It also states plainly: "Coerced consent is not consent."

On the cost of hiding who you are, ASAN writes that "Hiding autistic traits has been linked to worse mental health outcomes and increased suicidality in autistic adults." That evidence is about adults who mask autistic traits, not about children in one kind of therapy, and it is still a reason to protect harmless traits.

ASAN does not accept that modern ABA is different enough. We draw the line here: the ABA we practice follows the child's lead, leaves harmless traits alone, and teaches communication instead of compliance. That is the modern ABA we practice, and you are right to hold us to it.

How much research is there on assent in ABA?

Less than you would hope, and we think you should know that. The ethics code names assent, but only "when applicable." Breaux and Smith point out what that wording allows:

Outside expert, not affiliated with Budding Futures

The language of 'when applicable' when referencing assent allows for practitioners to decide when assent and assent protocols are utilized.

They also write that "The lack of published research can make assent-based practices seem to be a choice of the practitioner." A 2021 review by Morris, Detrick and Peterson looked at how assent is handled for research participants with autism and developmental disabilities, and concluded: "In short, very few articles that clearly addressed assent procedures were identified."

In the field of ABA, how to obtain assent, how to recognize assent withdrawal and how to record both are still being worked out. So assent is an ethical commitment more than a proven technique. Ask any provider, us included, how they define it, what they do when a child withdraws it, and how they write it down.

Common questions about assent in ABA

Can my child refuse ABA therapy?

Yes, in the moment. We honor a “no” and adjust. If your child is consistently miserable, that is a sign the plan needs to change, and we will change it.

What if my child hates it?

Tell us. Good therapy should be something your child can tolerate and often enjoy. Dread is a signal, not something to push through.

Is this the same as the old ABA people warn about?

No. We do not punish stimming, force eye contact, or use aversives. The goal is communication and quality of life.

How do you know my child is okay in a session?

We watch for happy, relaxed, and engaged. When that slips, we pause and find out why.