Do Critics of FC “Presume Lack of Competence”? Part III: Jacobson, Mulick & Schwartz

History of FCValidation TestingFad Treatments
Written By Janyce Boynton

This blog post is the third in a series exploring Alicia A. Broderick and Christi Kasa-Hendrickson’s assertions that critics of FC “presume lack of competence” in individuals being subjected to FC. In this series, I am reviewing each of the four articles they cite as “proof” of this claim before circling back to a review of their case study “Say Just One Word at First.” (see note below).

A facilitator “supports” the child’s wrist to select letters on a keyboard. (Image from a 1991 Syracuse University Training video).

Today, I’m reviewing “A History of Facilitated Communication: Science, Pseudoscience, and Antiscience” by John W. Jacobson, James A. Mulick, and Allen A. Schwartz.

As with the other authors previously reviewed, Jacobson, Mulick, and Schwartz have the educational credentials and work experiences that make Broderick and Kasa-Hendrickson’s assertion difficult to believe and requires no further discussion.

Given that Jacobson, an associate planner with the New York State Office of Mental Retardation and Developmental Disabilities, helped examine FC in 1992 for the Psychological Division of the American Association on Mental Retardation (now the American Association on Intellectual and Developmental Disabilities), it is easy to see why proponents would not want their potential supporters to read what he had to say.

The AAIDD, btw, opposes FC and RPM.

AAIDD Position Statement regarding FC and RPM. January 9, 2019.

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.

Jacobson, Mulick, and Schwartz associate the rise of FC popularity in the U.S. with a cultural shift that was taking place in the field of Developmental Disabilities Services. As the idea of deinstitutionalization took hold, communities were unprepared for the transition of individuals with a wide range of disabilities out of institutions and into public and private health programs. As individuals were removed from institutions, community supports, and professional services were tasked with serving “ever more complex clientele.”

With rapid reforms, licensing and certification requirements for professionals were loosened to accommodate the need for staffing. As a result, otherwise well-meaning parents, caregivers, and educators began using training methods and therapies that appeared to be “the most culturally normative,” but lacked scientific rigor. Further, many of these individuals were “vulnerable to the false promise of dubious therapeutic techniques.”

The authors also noted that (some) authorities in the field contributed to the spread of these therapies by misrepresenting or misinterpreting the therapeutic effects to parents and staff. FC was among the techniques that appeared to offer hope when all other treatments seemed “less providential.”

Jacobson, Mulick, and Schwartz state:

 How do controversial treatments come to be adopted and their premises so widely accepted? …The critical elements, we believe, are an unexpected but apparently dramatic treatment response, a superficially plausible “theory” for this effect, and a disavowal by the proponent of conventional standards of scientific procedure and proof.

The authors assert that the phenomenon of FC satisfies many of the criteria of pseudoscience:

  • Demonstrations of benefit are based on anecdotes or testimonials.

  • Baseline abilities and the possibility of spontaneous improvement are ignored, and related scientific procedures are disavowed.

  • Therapists who use FC unsuccessfully are blamed for not doing it correctly or not believing that it will work.

  • Controlled research that disconfirms the phenomenon is criticized on grounds of rigor and procedure not even remotely addressed by studies that purport to demonstrate the effectiveness of the technique.

  • Select findings, rather than the composite of findings, of controlled studies are critiqued and interpreted.

In addition, much of the promotion of FC occurred outside of the peer-reviewed literature. Proponents relied on popular magazines, newspaper reports, television shows, and newsletters to promote FC. Most media accounts of the technique were “selective, incomplete, and inaccurate in their presentations.”

And, while these feel-good stories gained traction in the popular press, controlled studies demonstrably showed the FC-generated messages were controlled by the facilitators and not those being subjected to it. Contrary to proponent reports of antagonistic testing situations, these studies were conducted in familiar community service, educational, and institutional settings. The clients were matched with their most successful facilitator(s) who reported that their clients could produce multiple paragraph letters, self-reports and expositions while being facilitated.  

Biklen and a facilitator using FC with a student. (Image from a 1991 Syracuse University Training video)

Proponents, as we know, reject “testing for competence,” citing a concern that the testing situation is either too anxiety-provoking or too demeaning for the individuals being subjected to FC. Jacobson, Mulick, and Schwartz noted:

The credibility of FC rests on three explanatory constructs consistently put forth by proponents to account for incredible results: the lack of validity inherent in confrontational testing, word finding problems of people with autism, and the broad and unrecognized influence of developmental dyspraxia or apraxia.

The authors go into these constructs in detail, but the short version is that no scientific evidence exists to support these claims. Individuals have produced a great amount of information during controlled testing situations, but, unfortunately for proponents, the information obtained has been successfully and repeatedly linked to information they—the facilitators knew—but their clients did not.

As for claims that facilitators need to physically support their clients because of global or developmental apraxia? There is “no scientific or neuropsychologic support for this assertion.” (See blog post here). Autism is not characterized by a motor disorder that would prevent individuals from independently selecting letters on a keyboard.

Like Green and Shane’s article from before, I’m leaving out a lot from “A History of FC.” I highly recommend you read the whole thing.

For example, the authors address the alarming number of false allegations of abuse cases brought (via FC) to the court systems in the United States alone. They talk about the extensive history regarding autism, developmental disabilities, and cognitive impairments—all being discounted or rewritten by proponents of FC. And, they discuss political motivations of individuals, like Biklen, who established a reputation as a strong proponent of educational inclusion. They wrote:

It is perhaps a short leap from a position that people with disabilities should have a full range of opportunities to the position that people labeled as disabled are, in fact, not disabled at all.

This article, published in 1995, is documentation that the pseudoscientific, anti-scientific sentiments of FC proponents like Broderick and Kasa-Hendrickson are not new. And, while proponents of FC may be well-meaning and sincere in their efforts to help individuals with disabilities—and to bring about cultural changes in the way individuals with disabilities are perceived--they are doing so without considering the harms caused by the promotion of a disproven technique.

I’ll end with this Jacobson, Mulick, and Schwartz quote:

Too often fad treatments emerge in low incidence populations with severe handicaps, populations for which few, if any, curative treatments can be offered. Fad treatments are not benign; they supplant use of proven and reliable methods when these methods do not also appear to produce dramatic breakthroughs.

Scientists-practitioners and others who prepare, train, and supervise therapists, especially, have an obligation to balance exploratory use of experimental or unproven but seemingly promising techniques with skilled application of treatment methods that conform to accepted community standards and responsible interpretation of evaluation findings.

Next time I will be reviewing: Wheeler, DL, Jacobson, JW, Paglieri, RA, and Schwartz, AA. (1993). An experimental assessment of facilitated communication. Mental Retardation. Vol 31 (1), 49-60.

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).

Janyce Boynton
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