Assent-Based ABA Therapy: A Parent’s Guide

ABA, or applied behavior analysis, is a branch of psychology that encourages positive behavior changes. In therapy sessions, the therapist focuses on developing important skills, such as communicating needs, using the bathroom independently, having conversations, and expressing preferences. ABA isn’t just for autism, but doctors often recommend it for children diagnosed with autism due to strong research support, especially for early intervention. ABA therapy aims to build on each child’s strengths and interests to foster independence.

Assent-based ABA therapy is grounded in the child’s assent (or willingness to participate) and emphasizes focusing on the child’s needs and preferences to promote autonomy, dignity, and positive outcomes.

In this article, I’ll explain what assent-based ABA means, what to look for in a provider, and share practical questions you can ask providers to ensure your child is getting the best care.

What Does “Assent” Mean in ABA Therapy?

In ABA, “assent” is a child’s willingness to participate in therapy, while “consent” is a legal agreement, usually given by parents or guardians. This means a child can agree to participate or withdraw at any point during a session.

On the other hand, compliance-based ABA focuses on making sure a child follows instructions or learns a skill. This often uses hands-on prompting or more structured approaches, such as discrete-trial teaching (DTT). When compliance is the priority, kids may get rewards or attention only for doing the task, which can be frustrating.

So what does assent look like in practice? It really depends on the child. Some children can clearly say whether they want to work on a specific goal. You might be wondering what happens if they say no, or how they’ll get the therapy they need -we’ll talk more about that soon. For toddlers and kids who don’t use many words yet, we can look for non-verbal signs of enjoyment, excitement, or other ways they show interest. These signs might include:

• Smiling, laughing, or making happy noises that show enjoyment (you know your child best – any insight you can give to your therapy team is invaluable as they get to know your child!)
• Showing eagerness when entering the therapy space by running over to toys or materials, or approaching the therapy table
• Lighting up and smiling when they see their therapist
• Leading their therapist to their favorite toys or activities
• Asking to play a game or asking for their favorite toys
• Making eye contact
• Showing curiosity about toys or materials by approaching them

Just as important as assent is the removal of assent. This can look like a child verbally saying they don’t want to work on their activity schedule, for example. Other examples of removing assent might look like:

• Refusing to disengage from electronics in order to start the therapy session
• Running away from the therapist or the activity
• Crying, meltdowns, or turning away from materials
• Verbally saying “no” or “I don’t want to”

Keep in mind this list isn’t exhaustive, and reading cues can be tricky. Perceived assent may not always align with actual assent, so it’s essential that the child always has choices and agency during therapy (Morris, Detrick, and Peterson, 2021). The therapist should also be ready and willing to adjust if needed.

Why Assent Matters for Children

Emotional Well-Being

When therapists respect a child’s wishes and autonomy, the child learns to advocate for themselves. If their wishes are always ignored, they may stop asking and resort to harmful ways of expressing themselves.

Relationship Building

ABA therapy should be fun and positive. A child should enjoy sessions and like their therapist. This rapport is hard to build if the child is often forced to comply or ignored. A healthy relationship needs flexibility—if a child withdraws assent, the therapist should pivot and offer choices. Respect builds trust and safety in therapy.

Better Outcomes and Long-Term Impact

When learning is enjoyable, children are more willing to join. With encouragement and a safe space, they can build skills at their own pace. The goal is long-term independence.

How Assent-Based ABA Differs from Traditional ABA

ABA therapy offers various modalities, including naturalistic teaching and discrete-trial teaching (DTT). Naturalistic teaching is often child-led, occurs in familiar settings, and follows the child’s interests while creating learning opportunities.

DTT is the more “traditional” form of ABA, known for its highly structured, repetitive, and rigid approach, which may not engage younger children with limited attention spans. While important, it’s not the only method, especially for those who prefer different styles.

DTT can be appropriate for some children, but it may not suit every child’s learning style. In assent-based ABA, ask yourself whether your child appears to enjoy this approach and observe their engagement. The best method depends on what works for your child. Sometimes, a blend between naturalistic and DTT methods might provide a happy medium.

Rewards or reinforcers help most people learn new things, but it’s best to use rewards that naturally fit your child’s interests. For example, if your child loves slides but can’t yet climb the steps alone, building the physical skills necessary to climb the steps means they’ll get to go down the slide whenever they want. This is a natural reward for their progress.

However, using food as a reward outside of natural situations, such as mealtimes, can cause problems later. Food as rewards can be helpful for younger children or those just starting out, especially if they aren’t motivated by much else. But over time, it’s best to use food rewards less often. The same goes for electronics, even though they can be very motivating for many kids.

⚖️ Assent-Based ABA Therapy vs. Traditional ABA

Here’s a quick reference chart to help visualize the differences:

Traditional ABA                                   Assent-Based ABA

🪴Key Shift: From “Do what I say” → to “Let’s work together.”

Let’s imagine a kiddo named Timothy, age 4, about to start his ABA session. He loves trucks and is working on language skills. When he enters the therapy room, he sees his therapist taking the toy bins out and runs over to her. The therapist greets him: “Do you want to play with me?” Timothy nods. She asks, “Do you want the blue truck or the green truck?” Timothy points and says, “green truck.” The therapist hands him the truck, and they begin, weaving language practice into play. Timothy responds to the therapist’s questions and spontaneously asks for more trucks.

In this example, the therapist checks willingness by noticing Timothy approaching, nodding, making a choice between trucks, responding during play, and asking for more trucks.

If Timothy starts to get a little bored with the trucks, assent withdrawal may look like 1) not responding to questions or statements, 2) not using words spontaneously anymore, 3) moving away or turning away, or 4) showing signs of distress.

In this case, a therapist practicing assent-based ABA would notice these signs and provide him with some choices. Timothy’s therapist pulls out his choice board, with a few picture icons representing activities for him to choose from: play with trucks, sit on his favorite bean bag (where he takes a break), go outside, or have a snack. Timothy chooses the bean bag icon and takes a break. In a few minutes, his therapist will approach him again with the choice board to see if he’s ready to do something else. If Timothy says “no” or doesn’t respond, his therapist will respect his refusal and reapproach Timothy again in a few minutes, or wait to re-engage with him until he gets up and starts walking towards a new activity.

Questions Parents Can Ask Providers

Let’s talk about red flags and green flags to look for in an ABA therapist. I’ll provide a few questions you can ask your therapist, along with examples of red-flag answers (what you don’t want to hear) and green-flag answers (things you want to hear).

Q: “How do you incorporate assent into your sessions?”

• Red Flag: “I’m not sure what that means.”
• Green Flag: “I ask your child if they want to participate, and I look for non-vocal signs that your child is enjoying an activity and wants to keep participating. I also make sure to offer choices, honor your child’s requests as much as possible, and I change my approach when assent is withdrawn or something isn’t working.”

Q: “What do you do if my child refuses an activity?”

• Red Flag: “We have to continue with the activity; otherwise, your child will learn that they can escape from a task by refusing.”
• Green Flag: “I honor that request unless your child’s safety is at stake. I will also encourage your child to use words or other communication methods to ask for a break or to choose a different activity. At the beginning of ABA therapy, it’s especially important for your child to learn that asking for a break or communicating what they want actually works. Over time, I may incorporate other tools, such as using a timer, an activity schedule, or a behavior contract to motivate your child and encourage re-engagement with activities.”

Q: “How do you involve parents in supporting assent at home?”

• Red Flag: “I’ll send you home with a handout that has a checklist of ways you can incorporate assent at home.”
• Green Flag: “I’ll show you how we look for assent in the therapy session, and then I’ll have you practice with us during the therapy session. That way, you can work on teaching some of the same skills with your child at home. It’s important to know that you might not always be able to incorporate assent into every aspect of your life at home, but when you’re working on things like potty training or communication with your child, you can practice and learn how to look for assent.”

How to Know if Assent-Based ABA is Right for Your Child

If you’re wondering whether assent-based ABA would be a good fit for your child, there are a few factors to consider. Assent-based ABA may be a good fit if your child:

• enjoys choices
• likes to take the lead
• resists being told what to do
• has lots of energy, often moving from one activity to the next very quickly

Other factors to weigh include your child’s age, developmental level, and therapy goals. While therapy should encourage a child to make choices and maintain their autonomy and dignity, some children may need to learn the prerequisite skills before they can truly provide assent. In other words, sometimes assent-based ABA may start with “learning to learn,” such as distinguishing between choices, making choices, and showing preference. This is especially true for very young toddlers or children with more significant impairments. 

Remember that you are your child’s best expert! Professionals will make their recommendations, but it’s important to trust your instincts about whether or not a provider is a good fit.

Addressing Common Concerns

ABA grounded in assent probably sounds good, but you may be wondering how your child will learn if they have the option to refuse their assent. Let’s take a moment to consider common concerns.

Q: “Does this mean my child won’t learn important skills if they say no?”

Saying “no” doesn’t mean that a therapy session won’t be productive; it just means the focus of the session may shift away from more apparent goals. If a child says they don’t want to work on something, often being able to communicate that appropriately can be a goal in and of itself. It can also be an opportunity to expand the use of language by using full sentences to express themselves. At this point, it’s also important for the therapist to be able to pivot and use strategies to reignite your child’s interest. Many therapists are very good at this, especially once they get to know your child and what they enjoy.

Also, progress on important goals your child doesn’t enjoy may be slower, such as toileting, brushing teeth independently, etc. Therapy can still be goal-oriented, but it should be paced with respect for readiness.

Q: “Will progress be slower?”

It all depends on your child. With naturalistic teaching and a strong therapeutic relationship built on assent, progress may be faster than with a more structured approach. It’s also possible that progress may be slower, but over the long term, it leads to sustainable progress built on trust while empowering your child with the skills to make important choices about their lives.

The Future of ABA: Why More Providers Are Moving Toward Assent-Based Practices

In more recent years, concern has developed in the ABA and broader autism community about whether or not ABA is harmful or unethical. Some people who received ABA therapy have said that it was harmful to them. In addition, there is concern that ABA techniques have been used to reduce non-harmful behaviors, such as stereotypy (repetitive movements or vocalizations), that neurotypical people view as abnormal, but which often serve a purpose for the person engaging in them (stress relief or just enjoyment).

The accusation of trying to “normalize” neurodiverse individuals should be something that all ABA providers grapple with. It’s important to have conversations with your provider about this topic to ensure they’re informed and aware of the current discourse.

Although the concept of assent is not new to ABA, incorporating it into everyday practice becomes increasingly important as the field evolves to align more closely with trauma-informed care and neurodiversity-affirming practices.

Also, parents notice when their children aren’t enjoying therapy. Some ABA techniques, such as planned ignoring or extinction, may “work” clinically, but parents and children often do not like or prefer these interventions. Preferences are part of assent, and parents are pushing back and asking for more respectful and practical approaches.

Conclusión

ABA is an effective teaching technology with the potential to transform lives. In the enthusiasm to create meaningful change, however, ABA therapists should not lose focus on the client’s dignity and autonomy. The good news is that it doesn’t have to – ABA therapy can be effective and respectful.

With a little creativity, a lot of patience, and collaboration between you, your therapist, and your child, ABA grounded in assent can honor your child’s voice, build relationship skills, and set the stage for lifelong learning.

To close, remember to ask questions, ask providers to educate themselves if they are unfamiliar with assent, trust your gut, and know that your child’s comfort matters as much as progress.

Referencias

Morris C, Detrick JJ, Peterson SM. Participant assent in behavior analytic research: Considerations for participants with autism and developmental disabilities. J Appl Behav Anal. 2021 Sep;54(4):1300-1316. doi: 10.1002/jaba.859. Epub 2021 Jun 18. PMID: 34144631.

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