Do Critics of FC “Presume Lack of Competence”? Part II: Green & Shane
Today’s blog post is a continued exploration into Alicia A. Broderick and Christi Kasa-Hendrickson’s claim that critics “often presume lack of competence” of individuals communicating via Facilitated Communication (FC). In this series, I’m reviewing each of the four articles Broderick and Kasa-Hendrickson cited as “proof'“ of this claim in their case study “Say Just One Word at First” before circling back to review it. (See notes below).
This week, my focus is on Green and Shane’s “Science, Reason, and Facilitated Communication.”
At the time the article was published, Gina Green, who had earned her doctorate from Utah State University, was Director of Research for the New England Center for Autism (now the New England Center for children, Associate Scientist for the E.K. Shriver Center, and Clinical Assistant Professor, College of Pharmacy and Health Sciences at Northeastern University.
Howard Shane and Stephen Hawking at Boston Children’s Hospital (Boston Children’s Hospital Facebook page, 2018)
Howard Shane, who had earned his doctorate at Syracuse University, was director of the Communication Enhancement Center (CED), the augmentative communication program at Boston Children’s Hospital. He was also an assistant professor at Harvard Medical School’s Department of Otology and Laryngology.
With these credentials (and subsequent achievements) it hardly can be said that either of these professionals “often presumed lack of competence” in the individuals they served. It is a ridiculous, insulting, and ill-informed statement to make, so let’s put that to rest right now.
Green, Gina; Shane, Howard C. (Fall, 1994). Science, Reason, and Facilitated Communication. Journal of the Association for Persons with Severe Handicaps, vol. 19(3), 151-72.
“Science, Reason, and Facilitated Communication” provides an in-depth accounting of FC and its efficacy as seen through the lens of scientific inquiry. And, if you have not read this article in full, I strongly suggest you take the time to do so. The argument they make for investigating FC using reliably controlled methods is both compelling and still relevant today.
Image by Goh Rhy Yan
Green and Shane start their article with a list of organizations (American Association on Mental Retardation, American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics) and individuals who opposed FC and ask:
Why have these organizations and individuals been convinced by more than two dozen controlled scientific and clinical evaluations of FC rather than a handful of uncontrolled qualitative studies and thousands of supporting anecdotes and testimonials?
The answer to this question, they continue, lies in exploring a second question “Does FC enable people with disabilities to demonstrate unexpected skills?” Given that some people believe in FC and some people don’t, the answer, largely, depends on a critical analysis of both the evidence and the methods used to draw a reliable conclusion. Green and Shane spend the rest of the article laying out arguments in favor of using quantitative measures (e.g., controlled studies, single- or double-blind tests), with a focus on ruling in or ruling out facilitator influence during the typing activity.
They warn that subjective reports and incidental evidence are unreliable sources for determining whether individuals subjected to FC are, indeed, demonstrating unexpected skills. And further, these reports, based on unverified assumptions about FC, can cause harm:
Suppression and denial of authentic communication by people with disabilities;
Diversion of precious public and private resources from effective interventions to FC;
Inappropriate medical and educational treatment;
Expectations for outcomes that are not likely to be realized, resulting in guilt and disillusionment on the part of parents, facilitators, and others;
Blind, unquestioning acceptance of unproven assertions by large numbers of people working in disabilities fields;
Hostility on the part of FC adherents toward anyone who expresses doubts about FC’s efficacy or calls for evaluation by objective methods;
Intense pressure on facilitators to produce “success”; and
Unsubstantiated allegations of wrongdoing directed at family members and other caregivers.
“Our premise,” the authors write, “is that nonexperimental observational methods and subjective reports are not sufficient for determining if FC works, because they do not permit any plausible alternative explanations for observed effects to be ruled out with reasonable certainty.”
In other words, observations, descriptive studies, and personal accounts (e.g., qualitative methods or ethnographic studies) may be important and are often intriguing, but are not designed to rule out factors relative to facilitator influence during FC typing sessions:
Visual, auditory, or physical cues
“Error correction” by the facilitator
Student motivation and/or attentiveness
Intellectual/comprehension/academic skills of the student
Environmental distractions
Prompt dependency
Neurological impairments
Other factors that may influence an observer’s perceptions of authorship
Controlled, objective evaluation methods (e.g., quantitative methods), on the other hand, assist researchers in determining if an intervention “does what it is purported to do, and if so, how consistently, with whom, and under what conditions.”
By design, quantitative methods are the better tools for answering a primary question about FC’s validity, which is: “Does FC enable individuals with disabilities to produce messages that are unquestionably their own or are there simpler, more plausible explanations?”
It should be noted here that Douglas Biklen, who founded the “Facilitated Communication Institute” at Syracuse University (now the ICI), rejected controlled evaluation methods in favor of qualitative methods in his 1990 article “Communication Unbound,” even while asking the question “How, why, and with whom does FC work?” Broderick and Kasa-Hendrickson, it appears, have followed his example in promoting FC.
Canon Communicator printing out facilitated messages (Prisoners of Silence, 1993)
As a former facilitator, I was interested in how much Green and Shane seemed to understand about the facilitating process itself. They discuss both the physical and psychological aspects of FC--something that is often omitted in FC literature. For example, facilitators can control the typed messages, while (sincerely) denying they are doing so, because of a human tendency to seek out evidence--unusual spellings or word usage, for example--that confirms a belief in the technique. Essentially, we remember the “hits” and forget the “misses.”
They also discuss the pressures on parents, educators, and others to make FC “work” and how an emotional investment in the technique reduces the chances of detecting facilitator control and increases the likelihood that reported successes will be biased. This all rings true for me, having personally experienced some of this myself.
I am leaving out a lot in this blog post. Green and Shane discuss in-depth the need to address not just FC’s validity, but its reliability and generality as well. They make a distinction between the objective evidence and the descriptive evidence regarding FC and, where they can, point out discrepancies between facts (about FC and autism) and information that falls more into the realm of speculation and belief. They include in their discussion theoretical issues, ethical issues, legal issues (e.g., false allegations of abuse), the acrimony this topic can cause, and, briefly, address the personal attacks they’ve endured when reporting the results of objective tests of FC.
My take-away from reading “Science, Reason, and FC” is two-fold.
First, this article is a wealth of information. I am reminded, anew, just how much was known about FC in the early 1990s. And, while a lot of FC articles (both pro and con) seem focused on telling people what to think, this article is a rare gem that tells people why critics of FC advocate for reliably controlled testing. They make clear why believing in FC simply is not enough to determine authorship--even when that belief is supported by indirect, “naturalistic,” and incidental evidence.
Second, calling for reliably controlled testing for FC—or other communication methods and techniques—is not “presuming lack of competence” in individuals with disabilities, as proponents like Broderick and Kasa-Hendrickson would have people believe. Rather, it is calling into question well-documented facilitator behaviors that interfere with the communication process. Even when facilitators are well-meaning, they do not have the right to usurp the independent communications of people who rely on Augmentative and Alternative Communication (AAC) methods and techniques to be heard. If proponents want to do more than wish FC was AAC, then they will have to step up and do the rigorous work of science.
Next time, I will be taking a closer look at Jacobson, J.W., Mulick, J.A., and Schwartz, A.A. (1995, September). A history of facilitated communication: Science, pseudoscience, and antiscience. Science Working Group on Facilitated Communication. American Psychologist. 50 (9), 750-765.
Note: Broderick and Kasa-Hendrickson cited these specific studies in their article Say Just One Word at First”: The Emergence of Reliable Speech in a Student Labeled with Autism as “proof” that critics “presume lack of competence” in individuals being subjected to FC:
Calculator, Stephen N. and Singer, Karen M. (1992, November). Letter to the editor: Preliminary validation of facilitated communication. Topics in Language Disorders. Vol 13 (1); ix-xvi.
Green, Gina; Shane, Howard C. (Fall, 1994). Science, Reason, and Facilitated Communication. Journal of the Association for Persons with Severe Handicaps, vol. 19(3), 151-72.
Jacobson, J.W., Mulick, J.A., Schwartz, A.A. (1995, September). A history of facilitated communication: Science, pseudoscience, and antiscience. Science working group on facilitated communication. American Psychologist, 50 (9), 750-765.
Wheeler, D.L., Jacobson, J.W., Paglieri, R.A., and Schwartz, A.A. (1993). An experimental assessment of facilitated communication. Mental Retardation. Vol 31 (1), 49-60.
You can read all the blog posts in this series at these links (I’ll make them “live” as they are published over the next few weeks).
Do Critics of FC “Presume Lack of Competence”? Part I: Calculator and Singer
Do Critics of FC “Presume Lack of Competence”? Part II: Green and Shane
Do Critics of FC “Presume Lack of Competence”? Part III: Jacobson, Mulick, and Schwartz
Do Critics of FC “Presume Lack of Competence”? Part IV: Wheeler, Jacobson, Paglieri, and Schwartz
Do Critics of FC “Presume Lack of Competence”? Part V: Review of Broderick and Kasa-Hendrickson
Do Critics of FC “Presume Lack of Competence”? Part VI: In Sum, No.