Defining, measuring, and honoring assent: evidence from a community-based ABA clinic
Brittney L. Pauli, Jeffrey G. Gesick, Bethany ContrerasPurpose
The purpose of this practice-based research was to evaluate a systematic approach to measuring assent and responding to assent withdrawal in the context of applied behavior analytic services for autistic children. A second purpose of this research was to evaluate the effects of the assent measurement system and procedures on clinician behaviors.
Design/methodology/approach
This research was practice-based and was conducted in collaboration between a university and a local organization that provides services to children with autism. This research used a single-case research design, specifically a multiple-baseline design across three child participants and their service teams.
Findings
The authors’ findings serve as a proof-of-concept for the application of assent procedures within a clinical setting. They demonstrated that assent and withdrawal can be defined and measured, and withdrawal was consistently honored while having virtually no negative impacts on overall productivity or service delivery. The authors found that behavior technicians were able to consistently and reliably take data on assent and withdrawal behaviors, and these data indicated that assent was generally sustained at high levels for all participants. They also found that the participants emitted both withdrawal-disruptive and withdrawal-self-advocacy, although self-advocacy did not consistently displace disruptive forms of withdrawal.
Research limitations/implications
Limitations included a data collection system that likely overestimated withdrawal and may have obscured meaningful patterns, and that the intervention did not produce a full shift from withdrawal -disruptive to -self-advocacy for all participants. Due to the small sample size and conducting the study at one clinic site, more research is needed to assess the generality of our findings.
Practical implications
This study serves as a proof-of-concept demonstration of how to practically embed assent procedures into existing clinical practice to better support the ethical obligation to respect persons within the context of service delivery for children with autism. Further, this research contributes to more inclusive service delivery strategies for children with autism by building an initial evidence base for assent procedures within the context of clinical service delivery.
Originality/value
Despite a growing conceptual literature base that recommends including assent procedures in service delivery, empirical demonstrations of assent practices within clinical service delivery remain absent. Our study provides one of the first data-based demonstrations of assent procedures embedded within applied behavior analysis-based service delivery grounded in the recommendations of prior conceptual work.