Written by Alison Spanoghe, Behavior Analyst, Autism Spectrum Therapies (AST)
When I first started working in a school system with children on the autism spectrum in the early 2000s, my leaders told me to stick to my instructions — no matter what. They told me this would be best for the children in the long run. As a newbie, I followed orders.
Often, though, that approach led to anger, tears, and resistance from the children who needed my help the most. Despite science backing up the “follow-my-orders” approach, it didn’t always feel “right.”
Today, my approach has evolved to something called “assent-based practice.” It’s a model that puts an end to instruction through coercion. It prioritizes the child’s agreement to participate in therapy rather than mandating that they follow orders.
The Old Way: Extinction
If you’re familiar with applied behavior analysis (ABA), you may have come across the term “extinction.” In simple terms, extinction means not reinforcing a previously reinforced behavior. The aim is to reduce the chances of that behavior happening again.
Let’s say your TV remote stops working. After a while, you’ll stop pressing the power button and maybe look for batteries or ask for help instead. The same principle applies to ABA services. If a certain behavior — like screaming — is not encouraged, the child will eventually stop doing it. You could then teach them a better way to communicate their needs instead of screaming.
While that might be good in theory, behavior isn’t always that straightforward. Also, the extinction approach can sometimes lead to other issues, like longer tantrums, aggression, or even distrust toward caregivers. That’s where assent-based practice comes in.
The New Way: Assent-Based Practice
Assent-based practice focuses on making sure the child agrees to take part in therapy — even if that agreement is nonverbal. When a child is actively engaged, that’s one indication that they are communicating that they agree with participating in treatment.
This type of approach involves:
- Constant check-ins
- Respecting when the child no longer wants to participate in treatment
- Adapting the approach based on the child’s response
- Teaching the child to communicate
The goal of this technique is to equip children with autism with skills that are useful in any situation. It also helps them advocate for themselves and make it clear when they want to say “no.” It’s more of a compassionate way of providing care.
Why Assent-Based Practice?
There are many benefits to using assent-based practice. It can:
- Build Trust: It helps establish a safe and trusting relationship between the child and the therapist.
- Promote Expression: The child learns that they are seen and heard. It encourages them to express their feelings.
- Respect Autonomy: The child’s “no” is respected, promoting their dignity and independence.
- Enhance Learning: This approach avoids standoffs. It allows more reinforcement of language use and engagement in the session.
Assent-based practice has become a popular topic in ABA services. It emphasizes getting the child’s agreement before continuing therapy. It teaches children to express their feelings. It also respects their dignity and independence.
Therapists can use this approach with any child at any time, leading to faster learning and better rapport with the child. While our understanding of assent-based practice continues to evolve, it is a worthwhile approach to consider because it puts the child first.
Alison Spanoghe is a behavior analyst with Autism Spectrum Therapies (AST).