Assent: Teaching Our Children Their Communication Has Power

Guest blog contributed by Alana Claxton, MA, BCBA (Board Certified Behavioral Analyst), Clinical Director at Marissa Bennett Consulting‍

Keywords:

• Assent- a person showing willingness to participate in therapy
• Bodily Autonomy- a person feeling like they have the right to control what happens to their body
• Functional Communication- communication that helps a learner advocate to meet their needs
• Compliance- when an individual does what another person demands of them whether they want to or not‍

As parents, when we think of assent and advocacy, our minds might bring us to politics and policies or  professionally hired advocates, but the most paramount advocate your child will ever have is you. The therapists who join your child’s team might be the expert in their therapeutic approach but you are the expert on your child. This is why you will always be their best advocate for ensuring assent is used within their sessions. Figuring out what assent looks like for your child specifically is a great place to start your assent advocacy efforts.

How is assent communicated?

One of the largest misconceptions we see relating to assent is that it only exists for vocally speaking individuals, but that is not the case. Our body language, facial expressions, and the gestures we use can be some of the most honest and expressive ways we communicate. So often parents can tell what their child needs just by glancing at their expression or noticing a microscopic hand movement. When looking at assent in therapy with non-speaking children we can look at the same modes of communication. When training our staff on assent we teach them to ask questions such as these: does the learner’s body look relaxed when I approach or do they tense up?, does their facial expression look happy while we are in session?, and are they engaged and participating with what we are teaching? These are all questions that parents can consider when watching their children’s therapy sessions and interactions with their therapists. For children who have extensive communication skills we can have ongoing conversations about what skills are important to them to learn, if they want to participate in the interventions being used, what their preferences are within their therapy sessions, and if they feel like they are being treated with dignity and respect by their therapists. As an advocate for your child, you can teach their therapists how to best recognize what their assent to participate looks like. 

‍What if my child changes their mind?

Assent needs to be ongoing throughout therapy services. We may also see our children withdraw assent from tasks or activities they previously assented to participation in. It is important for your therapists to recognize and be able to address what it looks like when your child is withdrawing assent. Assent withdrawal may look like throwing learning materials, disengagement from participating activities, or other dysregulated behaviors. Our children’s willingness to participate in different activities can also vary from day-to-day depending on what is going on in their lives (how well they slept, if they had a good day at school, if their seasonal allergies are impacting them, if they are experiencing dysregulation). Their therapists should be able to recognize and adjust sessions when assent is withdrawn. Teaching the skills to be able to withdraw assent is an important part of a child’s ability to self-advocate. As a parent advocating on behalf of your child, this is a goal area you can address with your therapeutic providers as a priority. 

What are some green flags for assent being used in my child’s therapy?

Assent with your child will look unique to them and the way they communicate but these are some green flags that can help you to identify if assent is being prioritized within your child’s treatment:

• The therapist asking for consent and waiting for a response before physically assisting your child, especially when prompts involve making any physical contact with your child (i.e- if they need help with handwashing). This will show your child that they have bodily autonomy.

• The preferences of your child being included when developing goals.
• Our family, community, and cultural values are being discussed when determining goals.
• Having your child participate in selecting goals when able and giving them the platform to communicate what skills are important to them to learn.
• Self-advocacy being taught and honored during therapy.
• Your child’s providers need to honor their functional communication, especially the communication related to escaping tasks and taking breaks.
• Participation being based on motivation and engagement not coercion or force.
• Therapists identifying body language changes that signify when your child is withdrawing assent.

‍What are some red flags that assent is not being prioritized enough in my child’s therapy?

As your child’s assent advocate, it can be helpful to look out for red flag warning signs that assent is not being prioritized enough within their therapy sessions. Some possible red flags could be:

• A focus on compliance with therapist demands throughout the therapy sessions.
• A lack of individualized goals including your child’s preferences. 

• Dysregulation at the beginning of every therapy session and avoidant behaviors.
• A lack of relationship being built between your child and their therapist or therapy team.
• “Follow through” being prioritized over functional communication.
• Therapists showing inflexibility with meeting your child where they are at for the day. 
• Choices not being offered during their therapy sessions.

‍What is wrong with compliance?

Blanket compliance should never be taught to any individual during therapy. Teaching a child to comply with anything an adult tells them to do can put them in dangerous situations. By focusing therapy on compliance over functional communication, it tells the child to ignore their own wants, needs, thoughts, feelings, and body cues because the demands of others are more important. Rather than prioritizing blanket compliance a child should learn the value of following specific necessary instructions of trusted adults and have the ability to communicate discomfort or preferences and learn that their communication has power to change things in their environment. Compliance for safety skills can also be taught in specific environments or situations where it is a necessary skill to keep the child safe. For example, if we are walking in the parking lot we need to learn to comply with the instruction “stop” and when interacting with community helpers we need to learn to comply with answering their questions. When advocating for assent within our children’s services we will want to see therapists focused on building rapport and therapeutic relationships with our kids rather than a focus on compliance and instructional control.

‍About Alana Claxton MA, BCBA, Clinical Director

Alana is an autistic self-advocate and BCBA who strives to help transform applied behavior analysis into a more compassionate and person-centered therapeutic field where individual differences are celebrated and appreciated.

About Marissa Bennett Consulting

Alana found her home within the Marissa Bennett Consulting community over two years ago providing clinic, in-home, and school-based support to clients of all different diagnoses and ages. Our values-based approach emphasizes inclusion, quality, and compassion. At MBC we believe that every human has the ability and the right to learn and the best way to do that is through engaging and individualized teaching strategies. 

C.I.T.Y. of Support is grateful to Alana Claxton at Marissa Bennett Consulting for her participation as one of our organization's sponsors. Please note that the information and opinions presented here are specifically her own.  The purpose of C.I.T.Y. of Support's collaborative blog is to help connect families and professionals to different community resources, and we do not specifically endorse any particular recommendations provided herein.

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