An Alternative Interpretation of Unusual Communication? Part II
In this second blog post exploring Douglas Biklen’s “alternative interpretation of unusual communication,” I review Rosalind Oppenheim’s book Effective Teaching Methods for Autistic Children as it relates to Facilitated Communication (FC) and Biklen’s article Communication Unbound: Autism and Praxis.
Photo by Jay Chen
Biklen’s interest in Oppenheim’s work stemmed from her use of a hand-over-hand, touch-based technique with students at the Rimland School for Autistic Children*. Oppenheim “discovered” the technique in 1960 as a parent working with her own child, diagnosed with profound autism, and is credited with being the first person in the United States to use FC.
Oppenheim’s description of her technique closely resembled Australian founder Rosemary Crossley’s version of FC. Biklen distinguished between Oppenheim’s use of cursive writing and Crossley’s use of letter boards, but this is a moot point: FC proponents may also use pen and paper in their practices. Like Crossley, Biklen, and FC proponents that followed, Oppenheim did not believe that facilitators could guide their clients’ hands with a “mere touch of a finger” or that FC built dependence on the facilitator, despite her own anecdotal reports and quantitative research that suggest otherwise. She wrote:
Depending on the child and his specific deficiencies in this area, we usually teach writing (following earlier instruction in drawing lines, circles, crosses, and other geometrical forms) by manipulating the child’s hand, thus feeding in the motor patterns. We believe that the autistic child’s difficulties with writing stem from a definite apraxia just as the nonverbal child’s troubles with articulation do when speech finally develops. There seems to be a basic deficiency in certain areas of his motor expressive behavior. So, in teaching writing, we find that it is usually necessary to continue to guide the child’s hand for a considerable period of time. Gradually, however, we are able to fade this to the mere touch of a finger on the child’s writing hand. We’re uncertain about precisely what purpose this finger-touching serves. What we do know is that the quality of writing deteriorates appreciably without it despite the fact that the finger is in no way guiding the child’s writing hand.” (54-55) (Emphasis mine)
It is plausible that the facilitators believed they were not guiding their students’ hands—research into facilitator control bears this out. It is also possible (better than chance) that, in addition, they were guiding the written output during FC sessions without consciously being aware of the extent to which they were doing so. (See Ideomotor Response)
Rather than rule out (or rule in) facilitator influence by using controlled methods, Oppenheim accepted FC-generated messages on faith, modeling the “FC works because people using FC say it works” approach to (faux) scientific inquiry Biklen and his followers would later adopt. One student’s (facilitated) explanation for his dependence on the facilitator was “I can’t remember how to write the letters without your finger touching my skin.” (p. 55)**
Indeed, it was during an FC session with a student that Oppenheim developed her belief that autism could be a motor planning problem. This, I think, is what piqued Biklen’s interest in her work. Oppenheim included the following teacher-student exchange in the book. The answers (A) are facilitator-generated responses:
Q: How come you didn’t do what I asked you to? Didn’t you understand, or what?
A: I don’t know what the trouble is, really, not understanding or the fact that somehow I’m not ever sure that I’m right.
Q: How do you mean, ‘not sure you’re right?’
A: Not sure that I’m understanding what means what. Meanings of words have always mixed me up.
Q: I’m talking to you in words now. Are you mixed up about the meaning of what I’m saying?
A: No.
Q: Well, then—in what situations do words mix you up, then?
A: They mix me up in situations when the need to think interrupts the thing that needs to be done.
Oppenheim adds that
The nearest we can come to an interpretation of this problem is that to represent a kind of “I can’t think when I’m in motion” situation. (p. 94)
Oppenheim also included as further “evidence” an example of the same student playing A Tisket, A Tasket. Although instructions had been given, when it came time for the student to take a turn chasing another student, he did not understand what to do. Purportedly, he later wrote a full explanation of the game (with facilitation) and proved to Oppenheim’s and her colleagues’ satisfaction that his difficulties stemmed from a “seeming inability to translate comprehension into motor performance.”
To support her view of “this problem of comprehension versus performance,” Oppenheim quoted a paragraph from one of four experiments discussed in a chapter by Beate Hermelin in the book Early Childhood Autism: Clinical, Educational and Social Aspects (Wing, 1966).
Oppenheim claimed Hermelin’s work indirectly supported the idea that her student’s inability to be the chaser in A Tisket, A Tasket was due to a motor planning problem rather than a perceptual difficulty or language deficit. That is, her student understood the object of the game, but could not figure out how to make himself run around the circle.
But Hermelin and colleagues’ experiments focused on individuals’ responses to stimuli in the environment (e.g., light, sound, touch, social interactions) and how a limited responsiveness found in individuals with autism and others (termed, archaically, as subnormal or psychotic) affected their development of language skills (and visa versa).
The four experiments were designed to explore possible input deficits (e.g., under- or over-stimulation, disturbances in attention) or output deficits (e.g., impaired motor behavior, including the execution of speech, hypo- or hyper-activity, and mannerisms such as toe-walking or fingers-play) in autistic children that may inhibit their ability to perceive and interact with the environment.
According to Hermelin, the experiments seemed to support an impaired “input” side of the chain of events (e.g., recognition or perceptual functions) which contributed to inadequate responses in autistic children and not “output” deficits (e.g. motor tasks). In other words, individuals with autism missed perceptual (visual-spatial) cues that facilitate language development but could learn and perform motor movement tasks. If true, then Oppenheim’s observations about motor planning problems were not supported by the literature.
To be fair, Oppenheim was aware that her observations were scientifically unfounded and needed further investigation. But, like Biklen, she left the controlled research up to others. She wrote:
It would seem that research in this area—the problem of translating comprehension into motor performance—might provide some fruitful information about the specific language deficits of some autistic children.” (p. 96)
In his article, Biklen introduced Oppenheim’s book as part of a “small body of generally ignored literature on educational methods.” I am guessing that is because her teaching methods, though interesting, were, largely, anecdotal rather than evidence-based.
To her credit, Oppenheim advocated for all children to receive instruction in academics at a time when programs for severely disabled children were either not readily available or focused only on social skills. I think she and her colleagues at the Rimland Institute probably advanced the discussion in that specific area.
In addition, Oppenheim did not appear to be anti-science. She included 74 references (books and articles) to back up her claims about autism. These included information regarding behavioral characteristics of autism, training programs (e.g., vocational vs. life skills), diagnosis (e.g., autism vs. schizophrenia), speech and language development, operant conditioning, and the like.
Unfortunately, none of these resources applied directly to Oppenheim’s development and use of FC as an independent form of communication or autism as a motor planning problem.
In his article, Biklen claimed that Oppenheim’s book “did not contradict and may well support” his praxis theory. As we’ve seen, Oppenheim used FC without quantifying the procedure (e.g., ruling in or ruling out facilitator influence under reliably controlled conditions). Additionally, her observations about motor planning difficulties in autism were anecdotal with no reliably controlled evidence to make further determinations.
Did Oppenheim’s book provide a (scientifically reliable) alternative interpretation of unusual communication? No.
Did Oppenheim’s opinions not contradict Biklen’s own scientifically unsupported beliefs about FC and autism as a motor planning problem? Yes, I think this one is true.
*Bernard Rimland wrote the foreword for Oppenheim’s book and endorsed her work, despite stating publicly that FC was, for the most part, a “parlor trick” and ineffective for non-speaking individuals. In one article I found, he suggested that only 4 participants out of 200 in controlled tests showed proficiency with FC. That is a 98% failure rate. Controlled studies put the failure rate at 100%. It is fascinating to me that, while the odds are against facilitators being successful (a facilitator-controlled technique cannot produce independent communication), pretty much every facilitator on the planet puts themselves in the 0-2% category.
** I was not able to find any research proving that touching someone’s skin resulted in the development of language comprehension and literacy skills in the person being touched.
***I found it telling that Hermelin (unlike Biklen) advocated controlled studies to develop teaching and educational strategies rather than relying on “inspired guesses.” She wrote:
Fanciful interpretations only appear convincing when the behavior they seek to interpret is bizarre and unstructured, and the number of alternative theories correlates positively with the level of our ignorance. If such structure becomes apparent through experimental procedures and methods, a more sober, factual and precise approach becomes possible. (p. 170)
References:
Anonymous (1993, June 14). Technique began in Skokie Chicago Sun-Times. p. 5
Oppenheim, R. (1961). They said our child was hopeless. The Saturday Evening Post. p. 23, 56, 58.
Wing, J.K. (Ed.) (1966). Early Childhood Autism: Clinical, Educational and Social Aspects. New York: Pergamon Press.