Honoring Assent in Autism Services
Assent goes beyond traditional informed consent—it is the individual's active agreement to participate, offered freely and without coercion. Honoring assent is not just an ethical imperative; it’s a pathway to building trust and fostering meaningful progress.
What is Assent?
Assent, as described in the 2023 article by Breaux and Smith, refers to the voluntary agreement of an individual—often someone who cannot legally provide consent—to engage in a service or activity. It is more than the absence of objection; it is an affirmative, dynamic process that acknowledges the individual’s preferences, communication style, and autonomy.
For instance, a child might demonstrate assent by leaning into an activity, smiling, or vocalizing interest. Conversely, withdrawal of assent might look like turning away, saying “no,” or engaging in behaviors that indicate discomfort. Recognizing these cues requires attentiveness and a commitment to understanding each individual’s unique communication style.
Why Does Assent Matter?
Honoring assent is rooted in the principles of human rights and dignity. The United Nations Convention on the Rights of Persons with Disabilities emphasizes that all individuals, regardless of ability, have the right to make decisions about their own lives. In the context of autism services, this means respecting the voices and choices of those we support, even when those choices challenge traditional approaches to therapy.
Moreover, failing to honor assent can erode trust and exacerbate unsafe behavior. When a learner's dissent is ignored, it can lead to frustration, a breakdown in the therapeutic relationship, and even safety risks. Conversely, respecting assent reinforces that the learner’s agency matters, fostering a positive and collaborative environment.
Putting Assent into Practice
Incorporating assent into autism services involves several key steps:
Define Assent for the Learner: Assent is not one-size-fits-all. Practitioners must identify the behaviors that indicate assent or withdrawal of assent for each individual. This might include vocalizations, gestures, or other forms of communication.
Monitor and Respond to Assent: Assent should be continually evaluated throughout a session. If a learner withdraws assent—whether by saying “stop,” turning away, or engaging in avoidance behaviors—practitioners should adjust the activity or environment to address the learner's needs.
Teach Self-Advocacy Skills: Assent-based practices are an opportunity to build a learner’s ability to communicate preferences and make choices. Teaching skills like using an AAC device to say “all done” or expressing preferences verbally empowers learners to navigate their world with autonomy.
Modify Approaches: Sometimes, a withdrawal of assent reflects discomfort with specific features of an activity or therapy. In these cases, practitioners can adapt the activity to make it more engaging. This might involve incorporating preferred items, changing the pace of instruction, or adjusting task demands.
A Call to Action
Honoring assent isn’t just about following ethical guidelines—it’s about building relationships rooted in trust, respect, and mutual understanding. It’s about seeing the individual as a partner in the therapeutic process, not just a recipient of services.
As Breaux and Smith emphasize, integrating assent into practice requires ongoing reflection, education, and adaptation. But the payoff is worth it: a service model that truly respects the autonomy and dignity of every individual we support.
References
Breaux, C. A., & Smith, K. (2023). Assent in applied behaviour analysis and positive behaviour support: Ethical considerations and practical recommendations. International Journal of Developmental Disabilities, 69(1), 111–121. https://doi.org/10.1080/20473869.2022.2144969
