Does a 2014 FC Authorship Study Stand up to Rosemary Crossley’s Concerns about Validity?
Today’s blog post is an analysis of a 2014 authorship study (Saloviita, T, Leppanen, M, and Ojalammi, U.) using criteria gleaned from Rosemary Crossley’s book Facilitated Communication Training, as discussed in a previous blog post (See Are people who question FC/S2C/RPM evil?). The questions in bold (below) reflect Crossley’s concerns about the validity of authorship testing and address concerns by FC/S2C/RPM proponents that researchers are evil or uncaring people who “presume lack of competence” in their disabled clients.
The purpose of the 2014 study was to examine the authorship of messages using FC. 11 facilitators and 11 individuals with autism and/or severe developmental delays participated. Test protocols involved open (facilitator cue) and blind (facilitator cue or different cue) formats. The study involved six testing activities: object naming, picture naming, describing a picture, reading, name writing, and independent pointing. The testing occurred over a period of 4 months, with facilitator/student pairs participating in 3-5 sessions that lasted 20-30 minutes.
Please note that there is a review of this study on our website here, but if you haven’t read the study in full on your own, I strongly suggest you do.
Was the partner (facilitator) trained and experienced with the facilitated communication method? Yes.
In this study, two Finnish schools were selected for participation in the testing. Both schools made regular use of FC. Facilitators included special education teachers, personal assistants, and parents. While the experience and training of the facilitators varied from participation in 1-3 day in-service trainings to on-the-job training, there was “general agreement between the schools and the children’s families that facilitation provided a reliable form of communication. No disagreements between families and schools concerning the use of FC were reported.” (p. 215)
Facilitators were supervised by the local hospital district psychologist, the Finnish Association for Autism and Asperger’s Syndrome, and the neuropsychological clinic at the University of Helsinki.
11 classroom assistants served as facilitators for the test and were considered “the most successful in their work.” (p. 216)
Did the aid user (individual being facilitated) previously communicate fluently with that partner (facilitator)? Yes.
All the participants (11) had used facilitation for 1-3 years, primarily at the sentence level, in academic and non-academic contexts. The teachers and parents reported “that FC was an established form of communication for them. (p. 216)
With the exception of one student/participant, the aid user worked with their regular facilitator. For that one student, who only used FC at home, a facilitator was selected who was known to the student and who served as a classroom assistant for the school.
For the most part, facilitators worked with the same student throughout the testing, although “in a couple of cases…the task was divided between two assistants.” (p. 216)
Was the aid user (individual being facilitated) satisfied there was a genuine reason for the validation being sought and give consent to the procedure? Tricky question to answer.
Crossley (and other proponents of FC/S2C/RPM) believe that FC-generated messages represent the thoughts and desires of the individuals being subjected to its use. However, since the very reason for the controlled testing is/was authorship (e.g., ruling in or ruling out facilitator influence or control over letter selection) and no reliably controlled testing supports claims that FC-generated messages are independent and free from facilitator control, informed consent cannot be obtained using FC/S2C/RPM or any other facilitator-dependent techniques. (See Systematic Reviews)
The authors of the study did not mention how (or if) consent was obtained directly from the students or what techniques or methods were used to discuss the activity (e.g., FC, verbal confirmation, sign language, or evidence-based AAC).
Instead, researchers followed the ethical standards of the National Advisory Board on Research Ethics in Finland (2009) for individuals under the legal age of consent—as accepted by the University of Jyvakyla—and first sought informed consent from school principals to contact the parents of students with whom FC was regularly used. The parents were then informed of the purpose of the testing, after which, “all of the parents who were contacted agreed to allow their children to participate, and provided informed, written consent. A total of 11 children participated in the study.” (p. 215)
Ultimately, the students participated in the testing with their parents’ or guardians’ knowledge and permission, but it is difficult to tell from the report just how much the participants understood the purpose of the activity.
Did the aid user have experience with the validation task required and demonstrate the skills required by the testing procedure? Yes.
“Data collection activities were similar to normal communication therapy sessions, were performed in familiar surroundings with known staff, and did not include any strange or new elements, such as screening devices.” (p. 216)
Were researchers responsive to proponent concerns that testing be conducted in as natural a setting as possible? Yes.
Researchers specifically mention in their report concerns raised by (founder) Douglas Biklen about testing (1993, 2005) and the appropriate use of FC. They made the testing situation “as naturalistic and comfortable” as possible, using a school speech therapist familiar to all the participants and their facilitators.
“Testing was conducted in the speech therapy room for all but two participants, for whom testing, for practical reasons, was conducted in the classroom or a room adjacent to class. The situation resembled a standard speech therapy session.” (p. 216)
Were participants given opportunities to take breaks and/or end the session when tired, agitated, or simply done for the day? Yes.
Testing was discontinued if either the participant or the facilitator “manifested signs of discomfort or tension,” although the researchers noted that “a number of the participants were reported to resist the use of FC whenever it was used with them during the day” (and not just in the testing situation). (p. 216).
Conclusion
For all intents and purposes, it would appear Salovitta, Leppannen, and Ojalammi adhered to Crossley’s standards for conducting authorship testing by guarding against potential uncertainties that would put undue stress on the participants while participating in FC-generated activities. The participants (and facilitators) were treated with respect and in accordance with the ethical standards of the university overseeing the project.
Notably, however, the researchers rejected Crossley’s and Biklen’s admonitions not to test the technique and, perhaps, that is why the researchers drew criticism from the FC community.
Our readers familiar with FC/S2C/RPM research will not be surprised to learn that, the researchers (employing reliably controlled testing protocols) discovered that:
For all testing activities, a clear pattern of results was observed. In those situations in which the test item was known to the facilitator (an open condition), that participant, using facilitation, produced correct and often detailed responses. However, when the test item was not known to the facilitator (182 cases) or the keyboard was not visible to the facilitator (8 cases), only three correct or partially correct responses were obtained. (p. 221)
The researchers’ conclusions that “there is no evidence that FC was a valid form of communication for any of the 11 individuals who participated in this study” were consistent with the previous findings (see Controlled Studies and Systematic Reviews).
In addition, the authors noted how difficult it may be to discontinue FC use once it becomes entrenched in school practices “even in the presence of evidence that the message is being produced by the facilitator, and not the person with complex communication needs.” (p. 223)
As we’ve seen time and again with FC/S2C/RPM, it is easy for facilitators (and observers of facilitated sessions) to convince themselves that the technique works, but under reliably controlled conditions, facilitator influence and control (in the form of visual, physical, and/or verbal cues) can be detected. Therefore, researchers employing testing methods that control for facilitator cueing during letter selection are not “evil,” as portrayed in pro-FC literature, but are acting responsibly to ensure that the voices of individuals with complex communication needs are not (inadvertently) being supplanted by their facilitators.
Next time, I’ll be reviewing the following study:
Edelson, S. M., Rimland, B., Berger, C. L., & Billings, D. (1998). Evaluation of a mechanical hand-support for facilitated communication. Journal of Autism and Developmental Disorders, 28, 153-157. DOI: 10.1023/A:1026044716536
Recommended Reading
Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. (1993). Facilitated communication: A failure to replicate the phenomenon. Journal of Autism and Developmental Disorders, 23(3), 507-530. DOI: 10.1007/BF01046053
Montee, B. B., Miltenberger, R. G., & Wittrock, D. (1995). An experimental analysis of facilitated communication. Journal of Applied Behavior Analysis, 28, 189-200.
Mostert, M. (2010). Facilitated communication and Its legitimacy — Twenty-first century developments. Exceptionality: A Special Education Journal, 18 (1), 31-41. DOI: 10.1080/09362830903462524
Mostert, M. (2001, June). Facilitated communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders, 31 (3), 287-313. DOI: 10.1023/A:1010795219886
Saloviita, T, Leppanen, M, and Ojalammi, U. (2014). Authorship in facilitated communication: An analysis of 11 cases. Augmentative and Alternative Communication, 30:3, 213-225. DOI: 10.3109/07434618.2014.927529
Simpson, R., & Myles, B. (1995). Effectiveness of facilitated communication with children and youth with autism. Journal of Special Education, 28(4), 242–239.