As most of us know, the BACB released the new code of ethics that requires Behavior Analysts to obtain assent from clients when applicable (2.11 Obtaining Informed Consent). But what does this mean when specifically providing care to a client?
Although it has been an essential practice for many ABA practitioners to obtain informed consent from parents at the beginning of services or new interventions, you probably haven’t heard about clinicians getting the consent from the actual clients during their sessions, especially in the field of ABA Therapy or special education. Obtaining written or verbal consent may seem impossible, specifically when you are working with individuals who are not only a minor but who may have limited communication skills. And even if you were somehow able to obtain consent from them, how confident would you be that your clients would give you consent for your treatment?
That is why to date so many ABA graduate programs have not taught their students to measure assent to the behavioral interventions through the use of measuring assent withdrawal. Although many behavior analysts work with one of the most vulnerable populations, there has not been much research in the area of assent withdrawal. The concept is very challenging for some behavior analysts. But we believe that it is an important part of treatment and that clinicians must clearly understand what it is and how to apply it into their daily practices. Assent withdrawal will help decrease the temptation of using extinction when managing escape avoidance behaviors and avoid the use of aversive control.
Historically, “old school ABA” has received so much criticism for teaching young children with autism robot-like speech, over-emphasizing compliance, and facilitating whatever “normal behaviors” appear to be to the caregivers or practitioners. Where children’s various forms of escape avoidance behavior from teaching activities were put on extinction and the intensity of the problematic behaviors was closely tracked until the children no longer engaged in those behaviors. But we know that this type of therapy has ended and it is time to rebuild a new reputation for our science and methods and do it justice. This “new school ABA” is a kind and compassionate version of our science.
So what is assent withdrawal?
When we observe a learner who is engaging in escape avoidance behavior from a task, what is the situation telling us? Simply put, he or she is not happy with something. The topographies of the behavior could vary from turning away, crying, pushing away materials, to whining through an activity. It’s even some of the behaviors we exhibit as an adult while completing an unpreferred task.
Assent withdrawal should be tied to the concept of happy learners. It is key for success when shifting from the “old school ABA” that uses a heavy amount of negative reinforcement by relying on aversive control when presenting teaching activities. The new school of ABA truly takes the concept of “the learner is always right” into account. When the learners engage in escape avoidance behaviors from the teaching activities, behavior analysts could honor the assent withdrawal and analyze what environmental manipulation needs to be made. Using the technology of ABA, we all should strive to create learners who love coming to their therapy sessions and find learning to be fun. The therapists have become the conditioned reinforcers, and the learners want to continue to interact with them. Ultimately, the learners cannot delineate the difference between work and play.
How do we get there?
There are some steps we can take to improve ourselves as Behavior Analysts who can create happy learners and do not have to rely on aversive control.
- Assent withdrawal measurement: It is important to differentiate task specific escape avoidance behaviors from generalized ones (e.g., seeing the therapist and running away, or being told to sit at the table and dropping to the floor, etc). The data collection to identify this distinction between those two will help behavior analysts develop some solutions to remediate the problem. After honoring an assent withdrawal, behavior analysts can investigate what went wrong. Was the activity too difficult? Were the stimuli aversive? How were the reinforcers identified and used? Once the modifications are made, behavior analysts should track and monitor data on assent withdrawal to further evaluate the problem. Assent withdrawal shouldn’t be happening across all programming. If it is, that means that you have not gained instructional control and need to work on pairing the instructional team, conditioning new reinforcers and creating the contingency that compliance with instructional demands leads to good things (and can be fun).
- Conditioning ourselves as a reinforcer through pairing: Instead of simply finding items that could work as effective reinforcers, we should focus on creating and eventually becoming one.
- Naturalistic teaching. We should be mindful of not spending excessive time in an artificial environment (e.g., table) if the programs are not set up to facilitate systematic generalization. If we could teach meaningful skills by simply contriving many learning opportunities in the natural environment, it will produce the maximum results efficiently. It also can make learning fun. It is important to blur the line between play and learning.
- More positive and less negative reinforcement. Although some could argue that it is difficult to completely separate positive to negative reinforcement, it does not mean that our search to identify quality positive reinforcers should stop. Behavior analysts should re-evaluate use of aversive control and escape extinction, which some might think is the only way for therapy teams to gain instructional control. Similarly, understanding what is controlling or maintaining behavior is different than having control. The use of negative reinforcement contingencies shouldn’t be the norm. The BACB code of ethics also requires behavior analysts to consider the use of reinforcement based strategies over punishment. We suggest going further into the use of positive reinforcement over the use of both negative reinforcement, escape extinction and punishment procedures.
Lastly, by incorporating assent withdrawal measurement into the daily therapy, the learners can build an essential foundation for self-advocacy skills. Behavior analysts should gradually shape their escape avoidance behaviors into more socially appropriate behaviors such as manding for cessation (e.g., asking for help or break), and eventually with more specifications (e.g., the duration of the task, level of assistance). This is extremely important for setting the learner up for success in becoming lifelong learners.
Chrissy Barosky MA BCBA LABA / Chief Clinical Officer
Fumi Horner PHD, BCBA-D / VP of Clinical Quality, Outcomes, & Research