Journal of Applied Behavior Analysis 2021, 9999, 1–17 NUMBER 9999 ()

Participant assent in behavior analytic research: Considerations for

participants with autism and developmental disabilities
Cody Morris
Department of Psychology, Salve Regina University

Jessica J. Detrick and Stephanie M. Peterson

Department of Psychology, Western Michigan University

Obtaining assent from potential research participants is an important component of research for
reasons related to ethics compliance, self-determination, and choice. However, unique issues
arise when working with populations who cannot assent through traditional means, such as indi-
viduals with Autism Spectrum Disorder (ASD) and related developmental disabilities (DD).
The purpose of this paper is to review and discuss assent practices within behavior-analytic
research to identify strategies that can be used to obtain assent from potential participants with
ASD and DDs. We began with a descriptive literature review of behavior-analytic articles that
included the term “assent” to identify what practices behavior analysts have used to obtain
assent from participants. In short, very few articles that clearly addressed assent procedures were
identified. Thus, we propose a model for gaining assent when working with individuals with
ASD and DDs.
Key words: assent, autism, consent, developmental disabilities, ethical research

Researchers are ethically obligated to obtain participation after their guardian has provided
permission from potential research participants consent. Assent is defined as a potential research
when enrolling them in a study. Consent refers participant who is not legally authorized to pro-
to a legally authorized individual providing per- vide their own consent for participation affirma-
mission for the individual’s participation in tively confirming their willingness to participate
research (Federal Policy for the Protection of in research (FPPHS, 2018).
Human Subjects [FPPHS], 2018). Often, con- In many cases, gaining assent is a straightfor-
sent is provided by potential participants them- ward process. For example, researchers may
selves. In some cases, such as for conserved simply ask a potential participant if they are
minors or adults (i.e., another individual has willing to participate in a task or study. In a
guardianship of the individual due to a lack of study involving typically developing children,
decision-making skills), the legal guardian may this might consist of the researcher saying to
provide consent for that individual’s participa- the child, “I’d like you to come over here and
answer some questions for me. Would you like
tion in research. In cases where potential
to come and do that with me?” The child
research participants are not able to provide con-
might respond, “Sure,” and walk with the
sent, they may still need to be given the oppor-
researcher. This could be construed as assent to
tunity to grant agreement (i.e., assent) for their
participate in research because it is an active
We have no conflict of interest to disclose.
affirmation of the child’s willingness to partici-
Thank you to Audrey Blematl for her assistance on this pate. However, obtaining assent may be com-
paper. plicated with other populations, such as youth
Address correspondence to: Cody Morris, Department receiving services in a juvenile delinquency pro-
of Psychology, 100 Ochre Point Ave, Newport, RI
02840. E-mail: [email protected] gram, children in foster care, and individuals
doi: 10.1002/jaba.859 with Autism Spectrum Disorders (ASD) or
© 2021 Society for the Experimental Analysis of Behavior (SEAB).
1
2 Cody Morris et al.

developmental disabilities (DDs). Programs for for all children to be involved in research
juvenile delinquency and foster care are compli- under a particular protocol, or for each
cated in that the settings may create a higher child, as the IRB deems appropriate. If the
IRB determines that the capability of some or
likelihood of coerced assent and there may also
all of the children is so limited that they can-
be complexities related to consent/guardianship not reasonably be consulted [emphasis
for those populations. The complications added] or that the intervention or proce-
related to obtaining assent for individuals with dure involved in the research holds out a
ASD and DD are primarily related to barriers prospect of direct benefit that is important
to their ability to provide assent. to the health or well-being of the children
According to the Behavior Analyst Certifica- and is available only in the context of the
tion Board (BACB) Certificant Data (2021), research, the assent of the children is not a
77.67% of behavior analysts practice within the necessary condition for proceeding with
domain of ASD and intellectual and develop- the research. Even where the IRB deter-
mines that the subjects are capable of
mental disabilities, as opposed to .09% of the
assenting, the IRB may still waive the
field that works within correction and delin- assent requirement under circumstances in
quency. Foster care is not currently listed as an which consent may be waived. (46.408)
option of professional emphasis by the BACB.
Because the necessary considerations for assent Given the requirements described in the
are idiosyncratic across all populations, a full FPPHS (2018), it seems apparent that
review of assent considerations for all the requirement to obtain assent could be
populations is beyond the scope of this paper. waived for many potential research participants
Thus, this paper concentrates on the specific with ASD and DDs. One reason that assent
assent considerations for the largest group of requirements would be waived is that partici-
research participants in behavior analytic pants need to be deemed capable to assent. In
research—individuals with ASD and DDs elaborating on what should be considered when
(Jones et al., 2020). judging an individual’s “capability,” the
One of the first steps to understanding assent FPPHS specifies age, maturity, and psychologi-
requirements is reviewing the applicable federal cal state as the primary variables. As ASD and
policies. The FPPHS (2018), often referred to as DDs are listed as diagnoses in the Diagnostic
“Common Rule,” is the standard federal policy and Statistical Manual of Mental Disorders
that outlines basic compliance requirements for (American Psychiatric Association, 2013),
all researchers working with human research par- members of IRBs may be prone to dismissing
ticipants. Within that document, expectations or waiving the assent requirement for those
for assent are specified as such: populations under the psychological state
preclusion.
The IRB [Institutional Review Board] shall A second reason that assent might be waived
determine that adequate provisions are for some research participants with ASD and
made for soliciting the assent of the chil- DDs is the age parameters stated by the
dren, when in the judgment of the IRB FPPHS (2018). The FPPHS defines assent as
the children are capable of providing “a child’s [emphasis added] affirmative agree-
assent. In determining whether children
ment to participate in research. Mere failure to
are capable of assenting, the IRB shall take
into account the ages, maturity, and psycho- object should not, absent affirmative agree-
logical state of the children involved [empha- ment, be construed as assent” (46.402). By the
sis added]. This judgment may be made federal guidelines specifying children as the
 Assent in Behavior Analytic Research 3

applicable population within the definition of also obligated to follow the Ethics Code for
assent, conserved adults would be exempt from Behavior Analysts (the Code; BACB, 2020)
assent requirements. when engaging in professional activities, includ-
Finally, a third reason that assent might be ing research. The Code (BACB, 2020) specifies
waived for individuals with ASD and DDs is that researchers must seek assent from potential
the FPPHS (2018) stipulation that participants participants “when relevant” (p. 18). Although
be able to be reasonably consulted. Although the relevant conditions are not described, the
the criteria for what “reasonably consulted” core principles included can be used as guid-
means are not specified, the second sentence of ance when interpreting code items. The four
the definition of assent provided in the FPPHS core principles of the Code are that behavior
provides at least one parameter of what may be analysts 1) work to benefit others; 2) treat
required. The definition of assent includes the others with compassion, dignity, and respect;
stipulation that failure to object is not sufficient 3) behave with integrity; and 4) ensure their
for assent. In other words, assent must be an competence. The first two principles—work to
active form of affirmation. Individuals with benefit others and treat others with compas-
ASD and DDs often have difficulty with speaker sion, dignity, and respect—are most pertinent
and listener skills. Autism Speaks (n.d.) approxi-
to assent.
mates that 40% of individuals with autism are
Benefiting others is described as both maxi-
“nonverbal.” Although the term nonverbal may
mizing benefits and doing no harm
be used inconsistently, it is reasonable to assume
(BACB, 2020). One of the tenets of benefiting
that the data provided for “nonverbal” individ-
others is “Protecting the welfare and rights of
uals refers to individuals who, at the very least,
other individuals with whom they interact in a
have extreme communication difficulties. There-
professional capacity” (BACB, 2020, p. 4). As
fore, obtaining affirmation from potential partic-
previously noted, the FPPHS (2018) are federal
ipants with ASD or DDs may be complicated
guidelines that specify the rights and protect
or not possible through traditional written and
the welfare of research participants. Therefore,
oral modalities. In these cases, some might argue
in the context of research, the core ethical prin-
the individual cannot be reasonably consulted.
ciple of benefiting others would seemingly defer
To summarize, the criteria specified for
back to the FPPHS guidelines discussed earlier
assent, as outlined in the FPPHS (2018), wai-
as some of the relevant conditions for assent.
ves the need to obtain assent for many poten- Again, strict adherence to the FPPHS guide-
tial research participants with ASD and DDs. lines would likely waive the requirement for
Specifically, assent could be waived for poten- assent for many potential research participants
tial research participants with ASD or DD who with ASD or DDs.
are: 1) deemed incapable to assent by an IRB The core ethical principle of treating others
due to their diagnosis, 2) are conserved adults, with compassion, dignity, and respect also pro-
or 3) are not able to be reasonably consulted vides important guidance related to the relevant
due to their inability to affirm their willingness conditions for assent. One of the tenets of this
to participate in research through traditional core ethical principle is “respecting and actively
means. However, meeting the standards of the promoting client’s self-determination” (BACB,
federal guidelines is not the only consideration 2020, p. 4). Self-determination can be defined
researchers must make when deciding whether as the ability of an individual to “act as the
or not to seek assent from potential research primary causal agent in his or her life and mak-
participants. For example, behavior analysts are ing decisions free from external influences”
4 Cody Morris et al.

(Peterson et al., 2021, p. 3). A second tenet of participants with ASD and DDs, the question is
treating others with compassion, dignity, and what technology exists within the science of
respect is “acknowledging that personal choice behavior that can be used to empower potential
in service delivery is important” (BACB, 2020, research participants to display self-determination
p. 4). Taken together, these principles add an and choice (i.e., assent or dissent) in relation to
important layer of consideration beyond simply their potential involvement in research.
adherence to the basic federal guidelines Our first purpose in writing this paper was
protecting the welfare and rights of research to identify possible assent technologies that
participants. That is, seeking assent is consis- could be applicable to potential research partici-
tent with the tenets of self-determination and pants with ASD and DDs by reviewing assent
choice, regardless of possible exemption as procedures used by behavior analysts broadly.
defined by federal guidelines. Seeking assent The scope of our review was not limited to
from potential research participants allows research that included participants with ASD
them to determine whether or not to partici- and DDs. Instead, we cast a wider net in hopes
pate through the act of choice making. of capturing any and all behavior-analytic pro-
Specific guidelines for when and how to cedures used to obtain assent. We cast this
emphasize self-determination and choice in wider net for two reasons discussed in the
working with research participants do not exist. review section. The second purpose of this
Rather, self-determination and choice are paper was to summarize the current state of
embedded in behavior analysts’ ethical princi- assent technologies used broadly in behavior
ples and values and should similarly be embed- analysis, to identify which technologies might
ded in the work of behavior analysts to the be applicable and useful with ASD and DD
maximum extent possible. Deciding how self- populations, and to propose adaptations and
determination and choice should be incorpo- modifications to these procedures for
rated into research participation via assent is a researchers to consider when attempting to
multifaceted issue. One of the largest variables obtain assent from individuals with ASD and
involved with self-determination and choice DD when necessary. Finally, we discuss the
with potential research participants harkens limitations of this review and future research
back to the issue of “capability.” In this case, that needs to take place in order to make
researchers must consider how to empower nuanced assessments of assent possible for indi-
potential research participants who do not have viduals with ASD and DDs.
the skills to actively communicate assent through
typical means (i.e., spoken or written agree-
ments). The FPPHS (2018) does not provide Review of Assent Procedures
guidance on nuanced strategies researchers can A literature review was conducted to identify
use to obtain assent because its purpose is only the strategies used to obtain assent in behavior-
to provide a basic level of protection for all analytic research. Although individuals with
human research participants across all disciplines. ASD and DDs were our primary interest, the
Nuanced strategies to obtain assent in review was not limited to that population for
populations with limited communication skills is two reasons. First, there is a dearth of published
something that has not been fully researched behavior-analytic articles specifically addressing
and likely needs systematic evaluation across a assent, both broadly and specifically, with
variety of disciplines in which research is con- respect to research with individuals with ASD
ducted with participants with ASD and DDs. and DDs. The purpose of our search was to
For behavior analysts conducting research with identify any and all applicable technologies for
 Assent in Behavior Analytic Research 5

obtaining assent, regardless of the specific par- included journals were reviewed from the first
ticipant characteristics. The second reason for issue to the time of the search (July 2020). We
not limiting the search to ASD and DD partici- searched for the word “assent” using Google
pants was the inconsistency in reporting demo- Scholar in each included journal. Each article
graphic information in many of the articles that included the word “assent” was then
reviewed. For example, some of the reviewed reviewed and coded for several variables
articles did not report demographic information (described below). Articles were excluded from
at all in their participant descriptions, whereas further review and coding if they met any of
other articles did report demographic informa- the following exclusionary criteria: (a) the arti-
tion but failed to connect specific assent proce- cle was inaccessible (i.e., no electronic copy was
dures with specific participants. Thus, only available), (b) the article did not describe an
descriptive information about assent procedures experiment where an independent variable was
and their overall prevalence was collected. manipulated so the effect on a dependent vari-
The review was conducted by searching the able could be observed (e.g., it was a discussion
journals listed on the Association for Behavior or review paper), or (c) the use of the word
Analysis International (ABAI) and Behavior “assent” was not related to the primary experi-
Analyst Certification Board (BACB) websites mental component of the study (i.e., assent was
that were searchable in Google Scholar. See used to refer to something other than partici-
Table 1 for a full list of the journals that were pant agreeing to partake in the study). Figure 1
included and excluded from the search based provides an overview of the search process,
on their availability in Google Scholar. All of the exclusionary criteria, and the number of
journals and articles included and excluded
(with reasons).
Table 1
List of Journals
Article Categorization
Journals Included in the Review
Behavior Analysis in Practice Each included article was then coded for the
Journal of Applied Behavior Analysis authors’ description of the procedures used to
Journal of the Experimental Analysis of Behavior
The Psychological Record obtain assent. The categories of methods
The Analysis of Verbal Behavior to obtain assent were “Waived,” “No Detail,”
European Journal of Behavior Analysis
Journal of Behavioral Education
“Minimal Detail,” or “Detailed.” Articles
Behavioral Interventions coded as “Waived” stated that assent was not
Perspectives on Behavior Science required for at least some of the participants in
Behavior and Social Issues
Experimental Analysis of Human Behavior Bulletin their study. Articles coded as “No Detail”
Japanese Journal of Behavior Analysis stated that assent was obtained but provided no
Journal of Organizational Behavior Management
Mexican Journal of Behavior Analysis further elaboration (e.g., assent was obtained
Monitor on Psychology for each participant). Articles coded as “Mini-
Education and Treatment of Children
Journals Excluded from the Review mal Detail” stated that either written or verbal
Brazilian Journal of Behavior Analysis assent was obtained but did not specify any fur-
Speech and Language Pathology and Applied Behavior Analysis
Psychonomic Society Publications
ther details about the assent process
The Journal of Early and Intensive Behavioral Intervention (e.g., written assent was obtained from each
participant). Lastly, articles coded as “Detailed”
Note. This table separates the journals that were included
in the review because they were searchable in Google provided specific information describing the
Scholar and the journals that were excluded from the components of obtaining assent. For example,
review due to not being searchable in Google Scholar. Slaton and Hanley (2016) stated:
6 Cody Morris et al.

Figure 1 The “Waived” category applied to the partici-

Search Process, Exclusionary Criteria, Number of Journals, pants under 12 years of age, and the “No
and Articles Excluded with Reasons Detail” category applied to participants who
Journals Reviewed
(n=20)
Journals Excluded, not
searchable in Google Scholar
were 12 years of age or older. The latter group
(n=4) was scored as “No Detail” because the study
described that assent was obtained, but no fur-
Articles identified through ther elaboration was provided.
data base searching
(n=23,468)
Interrater Agreement
Articles Excluded, the article To assess the reliability of the application of
Articles screened, included the
word “assent”
was inaccessible, the article
was not experimental, and the
the exclusionary criteria, two reviewers inde-
(n=226)
use of the word “assent” was pendently applied the exclusionary criteria to
not related to the experimental
component of the study 33% of the articles identified in the initial sea-
(n=39)
rch. The initial interrater agreement for the
exclusionary criteria was 89%. Every discrep-
ancy was resolved until 100% agreement was
obtained. The resolution process for each dis-
Participant assent was gained before each crepancy consisted of reviewers re-reviewing
session by asking each [participant] if they and discussing the applicable article. Addition-
were ready to begin working. An affirmative ally, the reliability of categorization of assent
response included any one of the following: procedures was also evaluated using the same
head nodding, saying “yes,” saying “okay,”
process. Interrater agreement was collected for
or coming to sit down in the designated
33% of articles with an initial total agreement
area. A rejection response included any one
of the following or a combination thereof: of 87%. Again, all discrepancies were resolved
saying “no thanks,” shaking the head using the same process.
implying “no,” or using an SGD to reject
participation (Molly). Mark never declined Results
any sessions; on rare occasions Molly
used her SGD to say “stop” or “all done” Sixteen behavior-analytic journals were
when asked to participate in sessions; these searched, with four excluded for not being
requests were honored. (p. 932) searchable in Google Scholar (see Table 1). There
were 23,447 total articles searchable across the
Some of the reviewed articles described assent journals, with 226 articles meeting the inclu-
procedures that were individualized across par- sionary criteria (i.e., included the word
ticipants. In these cases, more than one cate- “assent”). Thirty-nine of these articles were sub-
gory of assent methods could have been scored sequently excluded from the review based on
for a single article because different participants the exclusion criteria. One hundred eighty-seven
received different procedures. Studies that met articles were left to code. Of those articles,
the criteria for more than one category of assent 7 (4%) were coded as “Waived,” 124 (66%)
methods were coded under both categories. For were coded as “No Detail,” 33 (18%) were
example, the authors of one study stated that coded as “Minimal Detail,” and 28 (15%) were
assent was obtained for participants 12 years coded as “Detailed” (see Table 2). Five articles
of age and older, but not for the younger met the criteria for more than one category due
participants. In this case, the study was catego- to their utilization of different methods for dif-
rized as both “Waived” and “No Detail.” ferent participants. Therefore, the total count of
 Assent in Behavior Analytic Research 7

Table 2

Total Articles with Assent Procedures Listed

Total Articles Total Articles No Minimal

in Journal with “Assent” Excluded Waived Detail Detail Detailed
Behavior Analysis in Practice 552 23 3 1 15 3 1
Journal of Applied Behavior 4,550 48 5 1 29 3 11
Analysis
Journal of the Experimental 5,540 5 2 0 2 1 0
Analysis of Behavior
The Psychological Record 4,440 11 1 0 5 4 1
The Analysis of Verbal Behavior 470 12 1 1 6 1 3
European Journal of Behavior 494 5 2 0 1 0 2
Analysis
Journal of Behavioral Education 883 49 2 0 31 10 6
Behavioral Interventions 1,380 25 7 2 10 5 3
Perspectives on Behavior Science 124 1 1 0 0 0 0
Behavior and Social Issues 410 0 0 0 0 0 0
Experimental Analysis of Human 104 0 0 0 0 0 0
Behavior Bulletin
Japanese Journal of Behavior 79 0 0 0 0 0 0
Analysis
Journal of Organizational 826 0 0 0 0 0 0
Behavior Management
Mexican Journal of Behavior 275 0 0 0 0 0 0
Analysis
Monitor on Psychology 1,640 0 0 0 0 0 0
Education and Treatment of 1,680 47 15 2 25 6 1
Children
Total 23,447 226 39 7 124 33 28

articles across all of the assent categories exceeds assent. Each stated an approximation of “assent
the total number of articles included in this was obtained” and provided no further detail.
study by five. This slight skew is present in The 33 articles coded as “Minimal Detail”
reported percentages and explained within the included 14 articles that stated the procedures
application section (i.e., “Waived”). included written assent, and 20 articles stated
Of the seven articles coded as “Waived,” procedures included verbal assent (one study
three described the rationale for waiving assent stated that both written and verbal assent were
as being the participants’ ages (e.g., they did obtained).
not require assent for children aged 12 years Articles coded as “Detailed” described several
and younger), and four either described the idiosyncratic strategies for obtaining assent. In
participants as having insufficient language to an attempt to organize summary information
understand the assent form and/or having been about the “Detailed” strategies, we created
diagnosed with cognitive impairment or ASD. Table 3 to depict the various components of
Importantly, five articles classified as “Waived” the assent process described in the applicable
were also co-classified within the “No Detail” studies. Each article’s assent procedures are
(2) and “Minimal Detail” category (3). Co- summarized in Table 3 with an X marking
classifying these articles was necessary because corresponding components that were included
different assent methods were applied across in assent procedures. Nine of the studies
participants within the same study. included multiple components, which is appar-
All of the 124 articles coded as “No Detail” ent when more than one X appears in a single
were similar in their procedures used to obtain row. As nine studies are coded under multiple
8 Cody Morris et al.

Table 3

Articles Categorized as “Detailed” and the Described Steps for Obtaining Assent

Provided a Requested the Described the

written, pictorial, Described the Required participant use of attention
and/or verbal content of the observations Required experience the to increase the
description of question to of dissent/ a tactile procedures/ likelihood of
assent provided obtain assent assent response receive a tutorial assent
Allen et al., 2013 X
Van Camp & X X
Berth, 2018
Capriotti et al., 2012 X
Catania et al., 1989 X X
Catania et al., 1990 X X
Dillenburger & X
Coyle, 2019
Esch & Fryling, 2013 X
Forzano et al., 2011 X
Goodnight et al., 2019 X
Gunning et al., 2018 X X
Gunning et al., 2020 X X
Hangen et al., 2020 X
Harrison & X
Pyles, 2013
Lane & X X
Critchfield, 1998
Larson et al., 2011 X
Maki et al., 2020 X
Meadows & X
Skinner, 2005
Murphy et al., 2018 X
Oleson & Baker, 2014 X
Oswald, 1994 X X X
Powell & Azrin, 1968 X
Quinn et al., 2015 X
Sacks & Kern, 2007 X
Slaton & X X
Hanley, 2016
Stephenson & X
Hanley, 2010
Szalwinski et al., 2019 X X X
Willis & Mason, 2014 X
Yoo & Saunders, 2014 X

categories, the data summarizing the categories described observations of participant dissent
below exceed 100% if totaled. (e.g., signs of distress, facial expressions) as well
Of the 28 articles providing detailed descrip- as observations of assent (e.g., voluntary partici-
tions for assent, 50% described providing a pation in the activities, laughing) to determine
written, pictorial, and/or verbal description of assent for participation. Eleven percent incor-
the study for participants. Thirty-two percent porated the use of a psychomotor response,
described a process that included researchers such as asking the child to fill in a smiley face
asking the participants questions, such as, (to indicate assent) or a sad face (to indicate
“Would you like to participate in research dissent). Seven percent of studies outlined the
today?” or if the participant was ready to begin use of a tutorial segment and/or requested the
working/playing. Thirty-two percent of articles participant practice a sample of what
 Assent in Behavior Analytic Research 9

procedures would look like before seeking searched behavior-analytic research broadly for
assent. Finally, 7% outlined the use of provid- any and all assent procedures available to
ing more or less attention just before seeking behavior analysts. This analysis allowed us
assent to increase the likelihood of the partici- to assess the state of assent within applied
pant assenting to participation. behavior analysis as a whole. Although we
would have preferred to analyze variables
related to the demographics of participants
Discussion within the reviewed studies, the inconsistent
Considerations for obtaining assent from and minimal reporting of assent prevented us
potential research participants with ASD and from taking that approach.
DDs are multifaceted. Although compliance Our search for assent procedures within
with federal guidelines like the FPPHS (2018) behavior-analytic articles identified only
is a necessary prerequisite to conducting 187 articles that referred to obtaining assent
research with human participants, the broad from participants in experimental studies.
nature of comprehensive federal guidelines does These 187 articles came from a sample of
not provide discipline-specific considerations 23,447 behavior-analytic articles available to
for groups, such as behavior analysts con- search. Although not all 23,447 articles are
ducting research with individuals with ASD research articles, the vast majority of them
and DDs. More applicable guidance for behav- likely were empirical studies. Thus, it seems
ior analysts considering assent procedures can safe to conclude that obtaining participant
be found in the Code (BACB, 2020). The assent was not a commonly-referred-to consid-
Code indicates that compliance with federal eration in behavior-analytic research papers for
guidelines is required, but that more nuanced any type of participant—individuals with ASD
considerations such as self-determination and and DDs or otherwise.
choice are also important to maintain compas- Although some might consider the number
sion, dignity, and respect for groups served by of behavior analytic articles mentioning assent
behavior analysts. Thus, despite assent require- to be alarmingly low, there are multiple reasons
ments likely being waived for potential research why assent procedures may not always be
participants with ASD and DDs through the reported. One reason assent procedures may
federal requirements, behavior analysts must not be mentioned in a published article could
seek ways to empower the individuals they be that an IRB waived assent procedures
serve with self-determination and choice when according to the stipulations described in the
possible. Obtaining assent may be one opportu- FPPHS (2018) or other guidelines. If assent
nity for behavior analysts to empower self- was waived for a study, the authors might not
determination and choice, but the ability to do feel obligated to mention that assent was con-
so is reliant on available methods. sidered and waived. In fact, of the articles
In an effort to better understand behavior- reviewed, we found only seven articles that
analytic technologies available to enable more mentioned waived assent. Furthermore, in five
self-determination and choice through assent of these seven articles, waived assent was men-
when conducting research with individuals with tioned in relation to assent procedures that
ASD and DDs, we reviewed articles published were used with some of the participants. For
in behavior-analytic journals for content related example, a study with three participants may
to assent procedures. Notably, this review did have included assent procedures with two of
not specifically target research done with indi- the participants, but assent was waived for the
viduals with ASD and DDs. Instead, the review third participant. Thus, it appears that
10 Cody Morris et al.

researchers tend to mention waiving assent for common, specific strategies that researchers
some participants only if they first describe pro- could adopt difficult to ascertain. Additionally,
cedures for obtaining assent with other partici- the level of technical detail varied across arti-
pants in their study. cles, and many relied on written or verbal
A second reason that assent may not be descriptions of the study procedures and/or
mentioned in published articles is that compli- participants following the verbal or written
ance with assent procedures may be implied or instructions (e.g., mark the happy face if you
indirectly documented elsewhere. For example, want to come). Considering the language diffi-
many journals and/or publishers require culties prevalent in the ASD and DD
authors to sign an attestation for compliance populations, verbal or written descriptions are
with ethical standards as part of the submission not likely sufficient for obtaining assent.
process. As many aspects of assent are sub- Some strategies described in some studies
sumed under the ethical standards attestation, included in the review did stand out as poten-
many authors or editors may forgo mentioning tially being useful for research participants with
it in the manuscript to maximize the efficiency ASD and DDs. Specifically, some studies
of text in the article. required the participants to experience the rele-
Finally, a third reason that assent procedures vant procedures before seeking assent, and
may not have been mentioned in the reviewed others watched for behaviors they correlated
articles is that some of the articles may have with assent (e.g., voluntarily participating in
been retrospective or secondary studies that activities and smiling) and dissent (e.g., signs of
examined already collected data. In those cases, distress and facial expressions). However, none
assent would not necessarily be applicable and of the reviewed strategies seemed to completely
would, therefore, not be reported. This review capture every component of assent in a manner
did not exclude retrospective or secondary stud- that could be adaptable for individuals with
ies from the initial pool of articles searched. ASD and DDs. As a result, we sought to con-
The primary purpose of conducting this lit- ceptualize one possible alternative method for
erature review was to identify available technol- obtaining assent beyond those identified in the
ogies for obtaining assent that could be review.
applicable to potential research participants
with ASD and DDs. However, the majority of
the articles identified in this review provided Assent Through Concurrent Chains
little to no detail about their procedures Procedures
(i.e., they were coded as “No Detail” and One way to conceptualize assent is a freedom
“Minimal Detail”). Therefore, little informa- to choose whether to participate in a research
tion could be gleaned from a majority of the session or not (i.e., participate in another activ-
reviewed studies. Although these studies did ity instead). Catania (1980) notes, “Whether
not provide enough information to guide other behavior is regarded as free, controlled, or
researchers in obtaining assent, they did at least coerced, it involves choice, and choice implies
model the importance of considering assent the availability of alternatives. We may there-
and mentioning it in articles. fore interpret questions about the value of free-
Twenty-eight articles identified in this review dom as questions about preference for the
did provide specific details about their process availability of alternatives” (p. 98). If assent is
for obtaining assent. The identified procedures conceptualized as a choice, then concurrent
were fairly idiosyncratic across studies (see operant analyses may provide a method for
Table 3), making the identification of evaluating assent. Specifically, concurrent
 Assent in Behavior Analytic Research 11

chains schedules may serve as a useful method experienced the contingencies comprising the
for evaluating assent. In a concurrent chains treatment associated with that switch. The par-
schedule, participants choose between two con- ticipants were guided to do this at least three
currently available initial links (conditions) and times for each switch until they independently
then access the chosen condition, which may touched the switches when told to press a spe-
contain specific contingencies for responding cific switch. The order of switch instruction
during the chosen condition. Again, Catania and the position of the switches varied ran-
notes, “Concurrent chains schedules separate domly. After this, participant preferences for
the preference for different conditions the different treatments were evaluated by
(in initial links) from contingencies that main- arranging the three colored switches outside the
tain responding within those conditions therapy room and allowing the participant to
(in terminal links)” (p. 102). press one of the switches (initial link). After
Applied researchers have utilized concurrent pressing one of the switches, the participant
chains schedules to evaluate participants’ prefer- entered the therapy room and experienced the
ences for treatments for their problem behavior. treatment associated with the switch chosen for
For example, Hanley et al. (1997) used a con- 2 min (terminal link). This was repeated until a
current chains schedule to evaluate client pref- pattern emerged. Using this technology, the
erences for two different reinforcement-based authors were able to identify clear treatment
treatments for their problem behavior. One preferences for FCT for both participants. In a
treatment was a functional communication subsequent study, Hanley et al. (2005) used
training (FCT) package, and the other was a similar procedure to evaluate whether partici-
fixed-time delivery of reinforcement (NCR). pants preferred FCT treatment with or without
After an assessment of their problem behavior, the use of punishment contingencies. In all
each of these treatments was implemented with cases, the FCT package that included the pun-
the participants, and both were found to be ishment component was more effective in
effective in reducing their problem behavior. reducing problem behavior and, furthermore,
Therefore, the researchers evaluated the client’s was preferred by both participants.
preference to determine which treatment was In these studies, the participants were chil-
more preferred. First, the researchers conducted dren with ASD, DDs, and/or severe learning
training sessions, wherein participants were delays. With the exception of one participant
exposed to the contingencies they would expe- (who was noted to have vocal-verbal behavior
rience if they touched one of three micro- but also articulation problems so significant
switches, each of which was a different color. that her speech was unintelligible), the partici-
Pressing the blue switch resulted in the partici- pant descriptions in these studies did not
pant experiencing FCT, pressing the red switch include specific information about their vocal-
resulted in the participant experiencing NCR, verbal repertoires. However, the authors noted
and pressing the white switch resulted in the that all of the children had some listener
participant experiencing an extinction-based responses, including being able to follow one-
treatment (as a control; this condition pro- and two-step directions. All of the children had
duced no reinforcement and was hypothesized very severe problem behavior. From the fact
to be something the participants would have no that FCT was implemented for all of the partic-
motivation to select). First, the researchers ipants, one might infer that the speaker reper-
physically guided the participants to touch one toires of these participants were significantly
of the switches. Contingent upon doing so, the limited. Impressively, despite limited speaker
participant entered a therapy room and and listener repertoires, the authors were able
12 Cody Morris et al.

Table 4 discriminative for the contingencies that will be

Mapping of Concurrent Chains Procedures to the Committee implemented after it is selected. In the Hanley
on Bioethics Recommendations et al. (1997, 2005) studies, the different col-
ored microswitches were discriminative for the
Committee on treatment that would be implemented if
Bioethics (1995)
Recommendations Concurrent Chains Procedures touched. This could be conceptualized as
ensuring that participants have an awareness of
Ensure awareness of Establish discriminative stimuli
options associated with choice options the options.
Provide expectations of Prompt exposure to experimental Discriminative stimuli signal the available
procedures conditions that allow
interaction contingencies choices. Providing training trials, where partici-
Clinically assess Include a control option to pants are prompted to touch each discrimina-
understanding of evaluate response differentiation
options tive stimulus (in this case switches) and
Solicit expression of Implement concurrent chains subsequently experience the contingencies asso-
understanding procedure and assess
differentiation (alternate
ciated with that discriminative stimulus (in this
position of initial links with case, different treatments), provides participants
each trial) with expectations of the procedures to be
implemented. Randomly rotating the position
of the discriminative stimuli (switches) across
to obtain preference for treatment, suggesting trials ensures that participants are not making
that an evaluation of assent, or willingness to selections randomly or based on position bias.
participate in the treatment, could be obtained, This allows the researcher to assess the under-
even in cases where the treatments included standing of the options. Furthermore, including
punishment contingencies. These results sug- a control condition that is hypothesized to be
gest that a concurrent chains schedule could be very low preference and would not likely
a useful procedure for gauging assent for partic- be selected allows the researcher to ensure par-
ipation in research, even in cases where speaker ticipants understand the options. If participants
and listener repertoires are limited. frequently select the option that has no rein-
In 1995, a Committee on Bioethics forcing value or they select it in equal propor-
(American Academy of Pediatrics) issued guid- tion to other options, the researcher may
ance on what constitutes assent. Four criteria hypothesize that the participant does not
were described: (a) ensuring awareness of understand the options. An expression of
options, (b) providing expectations of proce- understanding may then be evaluated by
dures, (c) clinically assessing understanding of implementing the concurrent chains schedule,
options, and (d) soliciting expression of under- collecting data on the choices, and if a clear
standing. Although these criteria are not framed pattern emerges, then “understanding” and
in a behavioral manner, they objectively sum- preference may be inferred/demonstrated. Such
marize important attributes of assent that any a strategy requires few, if any, speaker skills and
model should include and could be conceptual- minimal listener skills (e.g., the ability to follow
ized behaviorally. Further, the steps utilized in simple one-step instructions and making a
a concurrent chains schedule could be concep- choice when told to “pick one”).
tualized as exemplifying these criteria. How Generalizing this procedure to an evaluation
each step in the concurrent chains schedule of assent for research participation might occur
maps on to these criteria is summarized in using the following steps. The researcher could
Table 4. For example, in a concurrent chains identify discriminative stimuli to signal each of
schedule, each stimulus in the initial link is the choices: (a) the conditions of the
 Assent in Behavior Analytic Research 13

experiment, (b) a typical activity, or (c) sitting this harkens back to the question about feasibil-
alone (control). The researcher could conduct ity and efficiency described above. A third
practice trials to teach the individual to touch question is what the alternative conditions to
the switches (i.e., ensure the response is in the the research procedures should be when arrang-
repertoire) and subsequently experience the ing a concurrent chains schedule. For example,
contingencies associated with each option would a demanding classroom task or a leisure
(i.e., exposure trials). Next, the researcher could activity be more socially valid? Finally, a fourth
conduct the concurrent chains schedule to question is whether a control condition is nec-
solicit an expression of understanding while essary and what an appropriate control condi-
rotating the order of the discriminative stimuli tion would be. In summary, there are many
(i.e., switches) to clinically assess understanding unanswered questions that need attention to
of the options. If the individual reliably selects make the concurrent chains schedule a viable
the option that produces the research condi- procedure for evaluating assent.
tions, then assent could be inferred, and affir-
mative agreement would be clearly displayed. Summary
In theory, the use of the concurrent chains A review of behavior-analytic research pro-
schedule appears to be a useful way to concep- duced little guidance for assent strategies for
tualize assent for research in individuals who potential research participants with ASD and
are not able to provide assent through tradi- DDs. This is most likely due to assent being
tional means, such as some individuals with technically waived for most research partici-
ASD and DDs. However, we are not aware of pants with ASD and DDs. For researchers seek-
any research on the utility of such an arrange- ing to empower research participants with self-
ment. Much research would need to be con- determination and choice, despite assent being
ducted to evaluate the feasibility of such a waived for their potential research participants,
procedure. Several questions would need to be limited options are available. Furthermore,
answered before this strategy could be adopted. potential research participants with ASD and
For example, one question is how feasible is it DD have very idiosyncratic needs/skills which
to utilize this strategy? It takes a fair amount of makes standardized procedures difficult to cre-
time to conduct a concurrent chains schedule ate. However, strategies such as the concurrent
analysis. Stimuli need to be identified, training chains procedure require minimal prerequisite
needs to be conducted so the stimuli become skills on the part of the potential research par-
discriminative for the conditions that will be ticipants, which may make them more widely
implemented contingent upon touching the useful for potential research participants with
stimuli, individuals need exposure to the con- varying/limited skills.
tingencies, and so on. For potential research There are many limitations to using concur-
participants who do not have the skills neces- rent chains procedures to assess assent for
sary to benefit from such a procedure, these potential research participants. For one, arrang-
skills would have to be taught first. The ing concurrent chains schedules can be labori-
amount of time this takes could make these ous and time-consuming. If potential research
procedures unfeasible. A second question is participants have the ability to communicate
how often such an assessment would need to through verbal means, more standardized
be conducted throughout a study. If assent can methods of obtaining assent (i.e., simply
be withdrawn any time and preferences are explaining the procedures and asking if the par-
known to change, it stands to reason that the ticipant is willing to participate) would be
assessment must be conducted frequently. If so, much more efficient. However, traditional
14 Cody Morris et al.

means of assent are not always possible for indi- is possible that behavior-analytic articles have
viduals with ASD and DDs. been published in journals beyond those
Concurrent chains procedures can be used to endorsed by ABAI and the BACB. The inclu-
maximize self-determination and choice of sion of other articles may have changed our
potential participants by enabling an evaluation findings. Future research could expand the sea-
of assent. However, self-determination and rch on the term “assent” to identify whether
choice are relative concepts that would still not any additional information can be learned
be absolute when using this arrangement. For about assent processes.
example, the concurrent chains procedure often As a result of these limitations, we were
requires that the potential participant be exposed unable to provide specific, meaningful recom-
to the contingencies before they are given the mendations for guiding decisions about
option. In that situation, self-determination and whether or how to obtain assent for potential
choice are limited during the forced exposure in research participants with ASD and DDs, as we
order to empower the participant to choose had hoped to do. Individuals with ASD and
later. Hence, it may not be possible to enable DDs have idiosyncratic needs that require
absolute self-determination and choice when uti- individualized procedures to obtain assent.
lizing any of the assent procedures discussed. Although the specific strategies we highlighted
Ultimately, all procedures are likely imperfect in this paper will not likely address every single
and not practical or possible in every situation. need of such potential participants, it is our
However, the point here is not perfection or hope that the information provided here can be
absolute self-determination and choice. Rather, used as a starting place and framework for
the goal is to maximize self-determination and researchers seeking assent. Furthermore, we
choice when and where possible for individuals hope that this paper serves as a prompt for
who are not always given the opportunity to researchers to further consider assent proce-
exert those concepts in their lives. dures and to evaluate ways to effectively obtain
assent from potential research participants with
ASD and DDs.
Limitations and Future Research Obtaining assent from potential research par-
There are multiple limitations to our litera- ticipants is a complex and understudied area in
ture review making it difficult to draw broad behavior analysis. Researchers interested in this
conclusions about the issue of assent in applied topic could prioritize discovering and validating
behavior analytic research. These limitations a wider range of assent procedures than what is
include our inability to obtain specific informa- currently available for potential participants with
tion about demographic variables, study type, ASD and DDs. The expansion of procedures
and other potentially interesting information. for obtaining or evaluating assent may come
However, the purpose of the review was to from further review and conceptualization of
identify any and all strategies behavior analysts methods to obtain assent, surveys of current
have used to obtain assent rather than analyze practices, and experimental analysis of possible
specific details about the conditions that assent procedures. For example, researchers interested
are targeted. in further literature review and conceptualization
Another limitation of the literature review of assent strategies might consider studying prac-
was that behavior-analytic journals and/or arti- tices used in other fields and modifying them to
cles might not have been included in our fit the scope of behavior-analytic research. Alter-
review despite systematically searching journals natively, researchers interested in conducting
listed on the ABAI and the BACB websites. It surveys related to assent procedures might
 Assent in Behavior Analytic Research 15

investigate how IRBs at different institutions (i.e., the FPPHS, 2018), researchers should still
handle assent/waiving assent or how assent is consider empowering their potential research
taught in research methods courses. Finally, participants by providing the opportunity to
researchers interested in experimental research give assent because it aligns with the self-
related to assent might consider comparing determination and choice values of the field of
methods of obtaining assent across different cli- behavior analysis and, more importantly, the
ent profiles. ethical principles described in the Code
Another important area for future research of (BACB, 2020). Gaining assent from ASD and
assent is the extension beyond individuals with DD populations can be challenging because
ASD and DDs. As mentioned in the introduc- individuals with ASD and DDs are often not
tion, assent may be complicated with many able to provide assent through traditional
populations, including youth receiving services means, such as spoken and written modalities.
in a juvenile delinquency program and children Thus, it is important for behavior analysts to
in foster care. Each of these populations has further develop and refine available technolo-
different nuances to consider. Researchers inter- gies for assent.
ested in extending assent research beyond indi- Our review of several behavior-analytic
viduals with ASD and DDs should consider journals provided limited guidance on potential
bringing attention to other populations by writ- assent procedures because it appears that
ing about the complexities and considerations researchers do not regularly describe their
involved in obtaining assent for research partici- assent procedures or whether they obtain assent
pation. Survey and experimental research in from their participants. Although there are
that domain would also be beneficial. many reasons a researcher may not report their
Finally, to aid in the endeavor of better assent practices, the lack of descriptions of
understanding assent, it is also critical that assent procedures in research articles makes it
researchers begin to report more explicit infor- difficult to identify what effective assent tech-
mation about their assent procedures – whether nologies might be available to researchers. Of
they were waived or utilized. Clearly stating if the procedures that are described in the
assent was waived and why will model the behavior-analytic literature, most rely on
importance of considering assent and help iden- the participant having listener and speaker
tify the prevalence of and reasons why assent is skills. Further development of other strategies
being waived. Reporting specific assent proce- appears to be sorely needed.
dures used in experimental studies will also We identified some potential strategies for
model the importance of considering assent, in obtaining assent, namely choice and concurrent
addition to providing guidance for researchers chains procedures. However, such strategies
seeking assent with similar populations. have not been researched thoroughly enough to
be useful to applied researchers. This is an area
ripe for future research. Strategies that are
Conclusion developed should meet several criteria:
Assent is a critical element of applied (a) ensuring participant awareness of options,
research. For behavior analysts conducting (b) providing participants with expectations of
research with individuals with ASD and DDs, procedures, (c) clinically assessing participant
additional considerations for obtaining or eval- understanding of options, and (d) soliciting
uating assent are necessary. Although assent expression of understanding. Research that
requirements are likely frequently waived by leads to a meaningful assessment of potential
IRBs in accordance with the federal guidelines participant assent, when participants have ASD
16 Cody Morris et al.

or DDs and don’t have the “capability” to Treatment of Children, 36(1), 61–72. https://doi.org/
assent using typical assent procedures, would 10.1353/etc.2013.0008
Federal Policy for the Protection of Human Subjects (2018,
go far to help practitioners and researchers pro- June). Authentic U.S. Government Information
vide their potential participants with opportu- GPO. Federal Register. https://www.ecfr.gov/cgi-bin/
nities for self-determination and choice. retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d75
13160fc3f&pitd=20180719&n=pt45.1.46&r=PART
&ty=HTML
Forzano, L. B., Michels, J. L., Carapella, R. K.,
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