Rethinking Assent and Readiness in Early Intervention for Young Autistic Children: A Developmentally Appropriate Framework for Participation

There is a growing conversation in our field around assent-based practice—but also a growing number of misconceptions about what that actually means in applied settings. When assent is misunderstood as “the child decides if we proceed,” it can unintentionally lead to reduced intervention, avoidance of important skill building, and confusion for providers.

This matters because young children—especially those in early intervention—do not yet have the developmental capacity for informed consent or long-term decision making. As clinicians, our role is not to remove expectations, but to adjust how we support children through learning.

This is important because it clarifies:

• the difference between assent and consent

• how these concepts apply (and don’t apply) to young children

• what assent-based, neurodiversity-affirming practice actually looks like in real clinical work

Most importantly, it shifts the focus from permission to participation, emphasizing a more accurate and developmentally appropriate framework: co-construction and collaboration.

Defining the Terms (Clearly and Accurately)

Consent - is a cognitive, informed, and future-oriented decision.

It requires the ability to:

• understand what is being proposed

• weigh risks and benefits

• consider future outcomes

• make an informed, voluntary decision

Young children do not have the developmental capacity for consent. This is why consent is provided by caregivers or legal guardians.

Assent - is often misunderstood.

In developmental terms, assent refers to:

• observable willingness to participate

• engagement vs. withdrawal

• behavioral indicators of comfort or distress

It is not:

• agreement to treatment plans

• agreement to long-term goals

• a fully informed decision

A young child cannot meaningfully “assent” to intervention goals in the same way an adult can.

Where the Misinterpretation Happens

There has been a shift toward: 👉 “If the child resists, we stop” 👉 “If they say no, we don’t proceed”

While well-intentioned, this can lead to:

• avoidance of essential skill building

• missed learning opportunities

• reduced support during challenging moments

That’s not assent-based care—that’s stepping out of the work entirely.

An Important Reality Check: How We Support All Young Children

This is where it becomes even clearer. We do not ask young neurotypical children for assent to:

• brush their teeth

• use the toilet

• get dressed

• go to bed

• wash their hands

These are: non-negotiable, developmentally necessary routines

And yet, with neurotypical children, we naturally:

• scaffold participation

• use playful engagement

• provide support through resistance

• co-regulate during hard moments

We don’t say: ❌ “They said no, so we stop brushing teeth”

We say: ✔ “This is hard—let me help you” ✔ “We’ll do it together” ✔ “Almost done”

The expectation remains. The support changes.

An ESDM Reframe: Co-Construction Over “Assent”

In ESDM, we don’t ask: “Do you agree to this goal?”

We ask: “How do we build this skill with the child?”

This is where co-construction and collaboration come in.

What Co-Construction Looks Like in Practice

Instead of: ❌ adult-driven demands ❌ or child-led avoidance of all challenge

We aim for: shared activity, shared regulation, shared success.

Core Principles

1. Follow → Then Lead

Start with:

• the child’s motivation

• their interests

• their current regulation

Then gradually shape toward the goal.

2. “Me + You vs. the Hard Thing”

Not: me vs. you but we’re in this together

3. Build Tolerance Through Support (Not Avoidance)

We still: ✔ teach difficult skills ✔ move through challenges ✔ shape behavior

But we do it by:

• adjusting difficulty

• increasing predictability

• embedding communication

• supporting regulation

4. Read Behavior as Communication

Instead of treating “no” as a stop sign, treat it as information:

• too hard?

• too fast?

• not meaningful?

Then adjust.

5. Maintain the Learning Objective

We do not remove expectations.We modify how we get there.

The Real Shift

Not: “Do you want to do this?” but “How can we do this together in a way that feels safe, meaningful, and successful?”

We don’t remove the hard things. We change how the child experiences them.

And importantly— 👉 we hold the same expectations for all young children. 👉 We just individualize the support needed to get there.

That’s what ethical, neurodiversity-affirming, developmentally appropriate practice truly looks like.

We’d love to have you join us!