I started this series with the intent to review Alicia A. Broderick and Christi Kasa-Hendrickson’s case study called “Say Just One Word at First”: The Emergence of Reliable Speech in a Student Labeled with Autism, but I got sidetracked by this comment:

“Over the past decade, research on the method has centered primarily around the issue of validating authorship in FC. This question stems jointly from the supported nature of the method itself (i.e., the provision by a facilitator of physical, emotional, and other supports in order to type) and the often presumed lack of competence of individuals communicating via the method (i.e., individuals with labels of autism, mental retardation, Down syndrome, and other developmental disabilities.” (p. 14, emphasis mine)

Images of facilitators “supporting” their clients by either holding onto their clients or holding the letter board. (Sources vary)

The authors cite Calculator & Singer, 1992; Green & Shane, 1994; Jacobson, Mulick, & Schwartz, 1995; and Wheeler, Jacobson, Paglieri, & Schwartz, 1993 to back up their claim.

In my previous blog posts (links below), I reviewed each of the studies cited, plus Broderick and Kasa-Hendrickson’s case study because:

1. I was curious to understand what the researchers said—in their own words—about their clients in relation to Facilitated Communication (FC) use; and

2. I thought reviewing the studies would help put Broderick and Kasa-Hendrickson’s article in perspective.

Today, I finish up this series with some thoughts about what I’ve learned from reading these five articles with Broderick and Kasa-Hendrickson’s quote in mind.

It is true that for the past 30+ years, research on FC has centered primarily around the issue of validating authorship. Whether you support or denounce FC, largely depends on how “authorship” is defined.

Proponents, like Broderick, Kasa-Hendrickson, Calculator, and Singer, focus on the FC output when defining “authorship.” Their studies tend to be client centered with very little attention drawn to the facilitator(s). They think of “authorship” as the “state or act of writing” that just happens to be achieved in this case with the facilitator providing “physical, emotional, or other supports in order to type.” (Broderick and Kasa-Hendrickson, 2002).

In addition, facilitators are taught to attribute agency solely to their clients, under the guise of “presuming competence.” They are taught to not test for competency and to reject the idea that their clients may have language deficits (or other developmental disabilities) that could interfere with the development of spoken language and/or literacy skills. And, because of this, proponents are likely to minimize or ignore concerns about unexpected literacy skills or facilitator control during the FCed sessions. By using qualitative or interpretivist methods to collect data (e.g, interviews, self-reporting, observation), proponents find the “evidence” to support their claims. Proponents, largely, believe that FC works because people, like Jamie Burke or Richard Attfield (who are being subjected to FC) say it works. As Broderick and Kasa-Hendrickson believed when they wrote their article:

It has become more widely recognized that the issue of validating authorship need not be the central forms of inquiry.

Severe motor problems or physical constraints do not prevent people from accessing legitimate forms of AAC independently (without facilitator control). Here, Stephen Hawking visits Stockholm on August 24, 2015 in conjunction with a public lecture on black holes and participation in a historic conference on Hawking Radiation. (Image by Frankie Fouganthin)

Critics of FC tend to view “authorship” as a function of the person producing the written output and are less likely to attribute “independent” authorship to facilitator-dependent, FC-generated messages. To be considered a legitimate form of Augmentative and Alternative Communication (AAC), FC would need to allow the person with complex communication needs to produce messages independently and without interference from the facilitator. It is precisely because critics believe in the client’s potential to communicate independently that they want to be sure the facilitators are not controlling the typed messages (covertly or overtly).

In some ways, critics’ concerns about the technique of FC have nothing to do with the people being subjected to it. Their concern is that the “physical, emotional or other supports” provided by the assistant or facilitator might (inadvertently) interfere with the client’s ability to type independently. Support may be a short-term intermediary step, but, at some point, the facilitator needs to relinquish control. Their study of FC tends to be as facilitator-focused as it is client-focused. To critics of FC, what is purported to be typed during FC sessions is secondary to who is controlling the typed messages. Thus, their data collection methods tend to be quantitative (e.g., reliably controlled single or double-blind assessments).

As Green and Shane wrote:

If FC is simply a form of support that enables individuals with severe communication impairments to reveal existing abilities that they cannot show by any other means, it should not be necessary for facilitators to know (or to be able to guess) what messages are expected, nor even to see the letter display while messages are produced. Thus, the simplest strategy for determining authorship, the one that can produce the most unambiguous outcome, is to control information available to the facilitator (e.g., visual access to the letter display; knowledge of items seen, heard, or otherwise experienced by their FC partner) and to have independent judges evaluate FC messages.

In the early 1990s, facilitators were much more closely aligned with the critics of FC than they are today. They were open to using FC—some, like those at the O.D. Heck Center, even completely believed in it—but were also concerned enough about facilitator control over authorship during FC that they participated in tests. Unfortunately, as we saw with the Calculator and Singer study, not all the authorship tests were reliably controlled. (See Critiques of Pro-FC articles).

Staff at the O.D. Heck Center in Schenectady, NY prepare for authorship testing that included trials where the facilitator was blinded to information available to the client. (Prisoners of Silence, 1993).

However, dozens of studies met the requirements for reliability (See Controlled Studies) and, time and again revealed facilitator control over FC-generated messages. The “problem” in these studies was not that the individuals failed to produce written messages via FC. There were plenty of answers given, both during the formal testing and “spontaneously” in-between trials. Rather, when the facilitators were blinded to the test stimuli, the messages fell within three main categories: 1) unintelligible, 2) based on information provide to the facilitator (and not the information provided to the client), and 3) correct but having no relation to the content being discussed (e.g., facilitator guesses).

From personal experience, I can tell you it is devastating to go into the testing believing in FC and come out of the testing with evidence that you, and not your client, are controlling the messages. It can be a painful and emotionally draining experience.

But fear of finding out the truth about FC should not keep people from participating in any tests that might challenge their belief in FC. If “authorship” means the independent act of translating one’s thoughts and feelings into words on paper, then facilitators—however well-meaning—owe it to their clients to make sure the words generated through FC are not influenced or controlled by the “emotional, physical, or other” support they provide.

Perhaps the biggest surprise for me, in reading these “early” articles is how much was known about the flaws in FC back then and how little has changed in the intervening years.

If proponents want FC to be recognized as a legitimate form of AAC, then they need to stop blaming the flaws in the technique on “presuming lack of competence.” This simply is not true. The success or failure of FC does not come down to a matter of faith. A technique that, by design, builds dependence on a facilitator cannot function as an independent form of communication for individuals being subjected to it.

But I am not saying anything new. Critics of FC, like Green, Shane, Jacobson, Paglieri, Mulick, Schwartz, and even Calculator (eventually) understood the importance of examining the facilitators’ behaviors during the typing activity. Facilitators play a significant role in making FC “work” and until their influence and control is ruled out, the FC messages cannot be considered the independent words of those being subjected to it.

Sadly, as we get email after email from parents and educators expressing concerns about facilitated people “graduating” from universities around the U.S. and/or the uncritical promotion of pro-FC movies like “The Reason I Jump” and “Spellers,” all we can do is sit back and watch history repeat itself. (See Movie Reviews)

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 VI: In Sum, No.

Facilitated Communication: a thoroughly discredited yet persistent technique

Do Critics of FC “Presume Lack of Competence?” Part VI: In Sum, No.

How might touch reduce the cognitive load of FCed typers?

Spellers but not Readers? Do facilitated individuals ever read books?

Facilitated Communication: a thoroughly discredited yet persistent technique