Do “Problematic Behaviors” Vanish with Facilitated Communication?
Several readers have pointed out that, for some individuals with autism, various “problematic behaviors” seem to disappear the moment the facilitator brings out the letter board to start a facilitated communication (FC) typing session. Proponents believe that, until they were introduced to FC by their facilitators, these non-speaking individuals were “trapped in a prison of silence.” The presumption, here, is that the individuals are not able to express themselves without typed facilitated support and that the behaviors they exhibit just prior to the facilitator offering them the letter board are an outward sign of frustration. Facilitators, then, interpret the quieting behaviors as happiness their loved ones or clients feel at the prospect of typing.
While it would be wonderful indeed if FC is blissful to those being subjected to it, I don’t know if that assumption can be made across the board (excuse the pun). FC is, after all, a facilitator controlled activity and without reliable measures in place ruling out facilitator influence, facilitators should assume they are contributing to the typed output and, therefore, should take caution when projecting onto their clients’ or loved ones’ supposed thoughts and feelings through typed, facilitated messages. To date, the evidence weighs heavily against proponents who claim the FCed messages are “independent” and, should, therefore, not be presumed to be those of the non-speaking individuals.
The individual being subjected to FC is physically trapped in a corner behind a chair and a table while the facilitator holds a letter board in the air during a typing session. (Kris Foglia YouTube video, 2018).
From what I have seen personally and observed in countless pro-FC movies, YouTube videos, and live interviews on Facebook and elsewhere, individuals being FCed rarely, if ever, initiate communication using the letter board. Facilitators both control and manage the typing sessions. In some cases, the facilitators prevent the FCed individuals from interacting with the communication device alone by grasping their clients’ hand and pulling it way from the keyboard. It makes me wonder what happens when the facilitator is not available at a time when the non-speaking person has something to type? What if the person interacts with the communication device independently? Can they identify the letters or spell out words by themselves? Is what they type nonsensical or structurally sound? How happy are they then?
Rather than happiness, I submit there may be alternative reasons why someone would automatically, mechanically, snap to attention when a letter board is presented to them.
First, the person being facilitated receives the most concentrated attention from the facilitator at the start of typing sessions. At these times, the facilitator signals or cues the start of the session, often by saying the individual’s name, altering vocal inflections and volume, tapping the letter board on the table, waving it in the air, repositioning their own bodies in an alert, upright position, and other “get ready” behaviors. These behaviors, ritualized and well-practiced, are intended to get the individual’s attention, and it works over time. (Except when it doesn’t. Facilitators tend to remember when their clients conform and forget when they don’t.) This concentrated attention from the facilitator may positively reinforce a quieting behavior, especially if the facilitator is someone the individual likes and wants to spend time with. Who wouldn’t like this seemingly undivided attention?
At 46 seconds into the video, the individual being facilitated reaches for the keyboard, but the facilitator pulls it away from the keyboard at this award ceremony. He’s only allowed to engage with the keyboard when his facilitator is in control. (Peabody Awards YouTube Video, 2018).
Second, when the person being facilitated does not snap to attention immediately, the facilitator provides a different kind of physical and verbal cuing that can be described as an orienting response. These cues are designed to grab the person’s attention quickly—like someone clinking a fork against a glass at a wedding reception or social event. This common attention grabber can silence a whole room. In the case of FC, the facilitator’s voice might be a bit sharper, more staccato, or louder. I’ve also seen Rapid Prompting Method (RPM) videos where the facilitator taps the individual in the face with the letter board. That, I am sure, is an unpleasant attention grabber, even if it’s just a love tap, and over time may serve as a deterrent. Presumably, it is more pleasant to comply with the facilitator’s requests and point to the letter board on cue than to get tapped in the face with the letter board.
Third, over time, the individual being FCed may learn that the sooner they submit to the facilitator’s will, the sooner they get to stop the activity or receive a reward. For example, Sue Rubin, featured in the movie “Autism is a World,” had her spoons taken away if she would not submit to the typing sessions. She is often seen in the movie with the spoons in her hands during daily activities or letting water flow over them while she holds them under the faucet—an activity that, truly, seems to bring her comfort. If she typed with her facilitators, she got the spoons back, presumably as a reward for compliance. As for the communication device, she is regularly seen in the film taking the device away from her facilitators and closing it to end typing sessions.
Ben focuses on an orange and black device while, at the same time, supposedly typing out a message. His “communications and regulations partner,” Sara, holds the letter board in the air and calls out letters. (Autism Society of America FB livestream, 2020).
In another example, Ben Breaux and his “communications and regulations partner,” Sara Wong, are being interviewed by Chris Banks of the Autism Society of America. Ben extends his hand toward the letter board held in the air by the facilitator. However, the letters he touches on the translucent letter board are often not the ones his facilitator calls out. During a facilitated discussion on gun rights, Ben bolts from the situation and goes to the kitchen for a snack. Ben repeatedly moves from chair to chair, stands up, and leaves the room during the interview without any outward sign that he’s engaged with or interested in the interview questions. The facilitator chases him from location to location. For much of the interview, he is more engaged with some sort of mechanical device which he uses independently and with seemingly appropriate fine motor skills or, as stated before, focused on eating a snack—two activities that appear to give him more comfort than facilitator-controlled typing.
In some videos, especially with RPM and S2C, individuals are physically trapped by the facilitator in a small space with chairs blocking their exit. It can be surmised that the sooner the student submits to the typing session, the sooner they are released from the enclosure. In a video called Soma and Samantha, Soma sets a timer to mark the duration of the typing session. While Samantha does appear to recognize letters and has the ability to spell a few words in this sample, she also looks at Soma or stares off into space at intervals while pointing at the letter board Soma holds in the air. Unfortunately, the audio for Soma is low and it’s difficult to know what she is saying or any verbal cues she is giving her student. It is, however, possible to see visible movements of the letter board as Soma holds it in the air and positions it for Samantha to make more desirable letter selections. In any event, Samantha rocks back and forth, vocalizes, claps her hands, and, at times, makes sounds of distress. She has laser focus on the timer when Soma takes it off the table and puts it on the floor. Samantha bends over in her seat to maintain eye contact with it. About 6 minutes into the video, Samantha says “time,” signaling she is done with the typing session, which Soma ignores. The second the timer goes off a few minutes later, Samantha bolts from her chair. Presumably, if FC brought happiness, she would not have to be imprisoned to participate and would voluntarily stay to type more.
Finally, the perceived changes by the facilitator may be just that: perceived. Although the FC guidelines say it is the role of facilitators to help their clients maintain eye contact on the board, it is impossible to sustain concentrated attention on the individual during the ongoing typing sessions. To make FC “work,” facilitators must look at the letter board, often calling out letters, and focus their attention on asking and answering questions. Even though on video, the “problematic behaviors” are still evident during the sessions, facilitators may report improved behaviors in their clients. There are plenty of examples—especially in the older, less slickly edited versions of FC videos—where the individuals being subjected to FC bite, hit, scratch, scream, close their eyes, stand up, and turn their bodies away from the facilitator(s), while the facilitators’ eyes are focused on the letter board and they merrily continue the typing.
In “A Mother’s Courage,” a purportedly successful FC user attempts to bite his mother’s arm while they are facilitating and then runs over to a wall and, disturbingly, bangs his head through the sheet rock.
In “Wretches and Jabberers,” an individual being facilitated by his mother, bolts from the typing sessions while his mother sits, bewildered and wondering why “he always does that.”
These actions by individuals being subjected to FC raise the question of how—or if—these changes in behavior are objectively measured by the facilitators reporting the changes. And, if the changes are real and not perceived, then do they carry over into non-facilitated activities?
In summary, it is possible that “problematic behaviors” may diminish with FC use, especially at the start of FC sessions. Concentrated attention from family members or friends, ritualized behaviors, and channeled focus on the letter board may all contribute to the real or perceived changes. Participants, too, may learn that submitting to the activity quickly may allow them to escape the activity sooner or get a desired reward. However, since FC is controlled by facilitators and the messages are, most likely, the words of the facilitators, it is anyone’s guess as to whether typing using FC brings the individuals happiness. Informal observations of individuals resisting facilitation suggest otherwise, but objective measures could be used to identify client behaviors and document changes (if any). This type of objective research would add to the understanding of how FC impacts individuals being subjected to it. In addition, comparative studies of behavior in these same individuals using evidence-based forms of AAC could provide information about how the individuals feel about being subjected to facilitator-controlled vs. independent forms of communication and, potentially, if they, themselves, would describe FC as a form of happiness.