Withdrawal of assent

Consent, assent, and dissent are separate

Informed consent comes from the person with legal authority and requires understandable information about the service, risks, benefits, privacy, choices, and right to decline or withdraw under the applicable rules. Assent communicates willingness when the person cannot legally consent and assent applies. Dissent communicates refusal, pause, discomfort, or withdrawal.

A parent's or representative's consent does not become the client's assent. A capable adult's refusal is their own decision rather than a lesser form of assent. A signed form, arrival at a session, or earlier participation cannot establish willingness for every later activity.

The BACB ethics hub identifies the current Ethics Code for Behavior Analysts. Its glossary defines assent as vocal or nonvocal verbal behavior indicating willingness to participate by someone unable to provide informed consent. It says a service organization or research committee may require assent and set assessment parameters. Standard 2.11 requires behavior analysts to obtain and document informed consent when required and assent when applicable.

That Code applies to BCBA and BCaBA certificants and people who completed an application. BACB has no separate jurisdiction over organizations or corporations, so the practice needs an operational policy for every workforce role.

Dissent can use any reliable communication form

Examples may include saying or selecting “no,” “stop,” “later,” “break,” or “all done”; turning away; closing materials; moving toward an exit; returning an item; pulling a hand away; crying; freezing; or a person-specific gesture. One action can have several meanings. Teams should learn from the person, family, communication specialists, context, and repeated observation rather than assigning a universal interpretation.

Define how the person shows willingness, uncertainty, pause, distress, and withdrawal. Include speech, sign, gesture, body movement, facial expression, writing, and augmentative and alternative communication (AAC). Describe what partners should do and how long they should wait.

The ASHA AAC Practice Portal says AAC users should always have access to their tools or devices. Keep the primary system or a tested backup available. Never require speech, eye contact, still hands, or one motor response before honoring a recognizable message.

Pause routine work and check what changed

For nonemergency activity, a recognizable withdrawal should trigger a safe pause. Create space, lower language load, preserve communication, and stop prompting the person to repeat or justify the message. Do not remove tokens, preferred items, attention, ordinary services, or future choices as a penalty.

Then check:

• pain, illness, fatigue, hunger, medication effects, sleep, and other health concerns
• sensory conditions, noise, crowding, temperature, lighting, touch, and privacy
• communication access, vocabulary, device charge, positioning, partner skill, and wait time
• whether the goal, task, materials, pace, prompt, person, or setting still fits
• recent events, trauma cues, misunderstanding, fear, and competing priorities
• which alternative, break, support, or later time the person prefers

Route health, communication, trauma, and other interdisciplinary concerns to the qualified professional. A refusal is information about the current conditions; it is not a diagnosis or proof of one behavioral function.

Immediate danger has a narrow response path

If pausing would expose the person or someone else to imminent danger, use the least restrictive response permitted by the current safety plan, law, setting, role, and training. Preserve communication when possible, stop the emergency action when the danger ends, and obtain urgent medical or emergency help when indicated.

“Safety” should identify the observable danger, authorized response, responsible role, and stop condition. It should not become a general reason to continue a routine lesson, exposure, physical prompt, or compliance demand. After the event, document what happened, required notifications, the person's communication, and needed clinical, medical, or system repair.

Redesign the conditions before resuming

The qualified clinician should review the goal, procedure, benefit, burden, risk, setting, supports, and partner response with the person and relevant decision-maker. Options can include ending the activity, changing the goal, altering the environment, offering another response mode, reducing dose, changing staff, adding choice, seeking consultation, or developing a gradual plan the person accepts.

Breaux and Smith propose assent-based ABA and positive behavior support procedures that honor vocal and nonvocal withdrawal. They explicitly describe a limited research base, so their model is practice guidance in an evolving literature rather than a separate BACB mandate or proof of outcomes.

Record the signal and the partner response

Document the observed communication, context, activity, health or access factors, partner action, elapsed time, outcome, clinical review, and plan change. Keep the original account and the person's own report where possible. Avoid labels such as noncompliant, manipulative, or attention-seeking in place of observable facts.

For skill measures, record withdrawal separately from an incorrect response or failed trial. State whether the opportunity ended, was excluded under a prewritten rule, or remained eligible for another reason. Report adult response with its own denominator.

A fictional example

Milo is a fictional ten-year-old who uses speech and AAC. Before a cooking activity, Milo chooses “yes” on AAC. When a mixer starts, Milo covers both ears, selects “stop,” and moves toward the doorway. The technician stops the mixer and clears the exit. Milo later selects “too loud.”

The clinician reviews sensory conditions and changes the plan to a quiet manual tool, advance sound choice, headphones when Milo wants them, and a tested stop message. The team does not make mixer tolerance a goal. Milo and the parent receive an accessible explanation and can accept, change, or decline the revised activity.

Across eight later nonemergency activities, Milo communicates willingness before seven and declines one. Three withdrawal events occur after activity starts. Partners pause within ten seconds in 3 of 3 and offer the agreed alternatives in 3 of 3. These counts measure partner follow-through in observed events. They do not prove comfort, freely given assent, treatment benefit, or future performance; Milo's report and every unplanned response remain part of review.