Study Notes on ASCENT in Behavioral Analysis from Podcast with Dr. Cody Morris

Introduction to the Podcast

  • Host: Matt Sicoria

  • Guest: Dr. Cody Morris, an Associate Professor at Salve Regina University and a prominent researcher in the field of Applied Behavior Analysis (ABAABA).

  • Topic: A deep dive into ASCENT (Assent) practices within treatment programming and clinical oversight.

    • Discussion revolves around the shifts in the BACBBACB Ethics Code (2.112.11) requiring behavior analysts to obtain assent from clients who are legally unable to provide consent.

    • Dr. Morris is highlighted for his academic contributions, specifically his work on the conceptual and practical frameworks of assent in Java (JournalofAppliedBehaviorAnalysisJournal of Applied Behavior Analysis).

Key Discussion Points
Comprehensive Definition of ASCENT

  • Formal Definition: Assent is the affirmative agreement of an individual to participate in an activity or treatment, particularly when they lack the legal capacity to provide informed consent (e.g., minors or adults with legal guardians).

  • Three Essential Pillars:

    1. Legal Status: The participant is not their own legal guardian.

    2. Informational Clarity: The individual is provided with information about the procedure in a manner they can comprehend, often utilizing visual aids, simplified language, or modeling.

    3. Voluntary Participation: The active absence of coercion and the presence of a choice to engage or withdraw at any moment.

  • ASCENT vs. Consent:

    • Consent: Requires legal capacity, full disclosure of risks/benefits, and is a formal legal requirement.

    • Assent: Focuses on the client’s willingness and agency, acknowledging that a legal 'no' from a guardian might be a 'yes' from the client, or more commonly, a legal 'yes' from a guardian might be a 'no' from the client.

Significance in Modern ABA

  • Client-Centered Services: Assent shifts the focus from 'compliance' to 'engagement,' ensuring that the client is a partner in their own success rather than a passive recipient of interventions.

  • Social Validity: Assent serves as a real-time measure of social validity—if a client repeatedly withdraws assent, the intervention may be viewed as unacceptable to the most important stakeholder.

  • Historical Foundation: Rooted in B.F. Skinner’s analysis of power dynamics; Skinner warned against the 'benevolent' use of control that ignores the perspective of the counter-conrolled party.

Practical Implications and Clinical Methods

  • Facilitating Assent for Non-Vocal Clients:

    • Observational Indicators: Monitoring 'Indices of Happiness' (smiling, vocalizing, engagement) versus 'Indices of Unhappiness' (crying, aggression, avoidant posturing).

    • Exposure-Based Choices: Before asking for assent, the client should experience a 'sample' of the intervention or reinforcer to make an informed selection.

    • Withdrawal of Assent: Recognizing that 'problem behavior' is often a functional communication of 'I do not assent to this.'

  • The 'Assent-Based' Environment:

    • Creating an 'Open Door' policy where a client can physically move away from a work area without receiving a 'stay seated' demand.

    • Balancing the 'Law of Effect' with the 'Right to Refuse.'

Philosophical and Ethical Frameworks

  • Free Choice vs. Fair Choice:

    • Free Choice: An abstract ideal where no external contingencies influence a decision (largely nonexistent in clinical settings).

    • Fair Choice: Providing the client with meaningful, accessible options within the boundaries of safety and therapeutic necessity. It involves transparency regarding why certain tasks are requested.

  • Distribution of Power: Ethical ABA practice involves deliberately giving power back to the client. This reduces the risk of 'learned helplessness' and fosters self-advocacy skills.

Implementation Challenges

  • The 'Safety Exception': The dilemma of maintaining assent during life-saving or high-priority safety interventions (e.g., preventing a child from running into traffic).

  • Systemic Barriers:

    • Insurance Requirements: Payors often demand high-intensity hours (3030-4040 per week) which may conflict with a client’s daily desire to participate.

    • Legal Conflicts: When a legal guardian insists on an intervention that the client clearly refuses.

Research Gaps and Future Directions

  • Tool Validation: While several checklists exist for 'Assent-Based Care,' many lack empirical validation. There is a need for standardized, peer-reviewed assessment tools.

  • Variable Analysis: Future research should isolate specific variables like the speed of task presentation or the type of social praise to see how they impact assent rates.

  • Skills Training: Investigating how to teach clients the specific skill of 'declining' appropriately so their refusal can be honored without escalating to dangerous behaviors.

Conclusion and Recommendations

  • For New BCBAs:

    • Prioritize building rapport (pairing) as a prerequisite for assent.

    • View 'refusal' not as a barrier to overcome, but as valuable data to inform treatment modification.

    • Stay humble and realize that the student is the best teacher regarding what they find reinforcing or aversive.

  • Final Thought: Dr. Morris emphasizes that protecting a client's right to say 'no' ultimately strengthens the significance of their 'yes.'