Misleading Articles About Autism and/or FC
Some pro-FC/RPM/S2C sites cite research that purportedly supports FC. These articles fall into several categories.
Articles that claim, but fail, to show that FC/RPM/S2C is valid
Shoener, R.F., Kinnealey, M., & Koenig, K.P. (2008). You can know me now if you listen: sensory, motor, and communication issues in a nonverbal person with autism, American Journal of Occupational Therapy, 62:5, 547-553 DOI:10.5014/ajot.62.5.547
Critique: This article, a case study of an RPM-user, claims that he achieves communicative independence but does not provide details. But cues can be auditory or visual rather than tactile, and typing on stationary surfaces, as opposed to held-up letterboards, can still be cued by a person sitting or standing nearby.
Woodfield, C. & Freedman, J. (2021). Barriers to knowing and being known: Constructions of (in)competence in research, Philosophical Inquiry in Education, 28(2) 70-208
Critique:
(1) The article assumes that the ability to read FC-generated text out loud is evidence of authorship. But decoding words into speech doesn’t prove authorship or even comprehension; it merely proves that the person has learned letter-sound correspondences and knows how to sound out words.
(2) The article also assumes that those calling for scientific validation of FC intend to “discredit” autistic people and deprive them of agency. But it is FC itself, as a scientifically invalid methodology, that deprives autistic people of agency.
(3) The article assumes that FC critics equate an inability to speak with an inability to think. But most people are familiar with intelligent non-speakers like Steven Hawking and members of the Deaf community.
Bigozzi, L., Zanobini, M., Tarchi, C., Cozzani, F., & Camba, R. (2012). Facilitated communication and autistic children: the problem of authorship, Life Span and Disability, 15:2, 55-74
Critique: The authors did not conduct any message-passing tests to validate authorship. (See Schlosser et al., 2014 in Systematic Reviews).
Botash, A.S., Babuts, D., Mitchell, N., O'Hara, M., Lynch, L., & Manuel, J. (1994). Evaluations of children who have disclosed sexual abuse via facilitated communication, Archives of Pediatric Adolescent Medicine, 148:12, 1282-1287 DOI: 10.1001/archpedi.1994.02170120044007
Critique: Evidence for FC is based on the fact that eight out of 13 sexual abuse allegations made by FC were substantiated by evidence of perpetrator confession. But people who spend many hours working closely with abuse victims, including facilitators, may become aware of signs of abuse. In addition, a number of abuse allegations by FC have turned out to be false. (see Harms/False Allegations).
Articles claiming that the linguistic characteristics of messages show that FC is valid
Bernardi, L., & Tuzzi, A. (2011). Analyzing written communication in AAC contexts: A statistical perspective, Augmentative and Alternative Communication, 27:3, 183-194 DOI: O.3109/07434618.2011.610353
Tuzzi, A. (2009). Grammar and lexicon in individuals with autism: A quantitative analysis of a large Italian corpus, Intellectual and Developmental Disabilities, 47:5, 373-385 DOI: 10.1352/1934-9556-47.5.373
Tuzzi, A., Cemin, M., & Castagna, M. (2004). "Moved deeply I am" Autistic language in texts produced with FC, JADT 2004: 7es Journées internationales d’Analyse statistique des Données Textuelles, 1097-1105
Niemi, J., & Kärnä-Lin, E. (2002). Grammar and Lexicon in Facilitated Communication: A Linguistic Authorship Analysis of a Finnish Case, Mental Retardation, 40:5, 347-357 DOI: 10.1352/0047-6765(2002)040<0347:GALIFC>2.0.CO;2
Critique: the stylistic idiosyncrasies of FC-generated messages do not prove authorship, and there are alternative explanations for why they occur. For a critical review, see Saloviita (2018), in Systematic Reviews.
Articles that find that FC/RPM/S2C reduces repetitive behaviors
Deacy, E., Jennings, F., & O’Halloran, A. (2016). Rapid Prompting Method (RPM): A suitable intervention for students with ASD? REACH Journal of Special Needs Education in Ireland, 29:2, 92-100
Chen, G.M., Yoder, K.J., Ganzel, B.L., Goodwin, M.S., & Belmonte, M.K. (2012). Harnessing repetitive behaviours to engage attention and learning in a novel therapy for autism: An exploratory analysis, Frontiers in Psychology, 3:12 DOI: 10.3389/fpsyg.2012.00012
Critique: These articles do not explore questions of authorship. Nor do they rule out alternative reasons for behavioral changes, for example the positive effects of attention, or the use of rewards to incentivize typing.
Articles that assume, rather than attempt to demonstrate, that FC is valid
Some of these articles are based, in part, on FC-generated messages that the authors assume are coming from the people being facilitated rather than from their facilitators.
Bonneh, Y.S., Belmonte, M.K., Pei, F., Iversen, P.E., Kenet, T., Akshoomoff, N., Adini, Y., Simon, H.J., Moore, C.I., Houde, J.F., & Merzenich, M.M. (2008). Cross-modal extinction in a boy with severely autistic behaviour and high verbal intelligence, Cognitive Neuropsychology, 25:5, 635-652 DOI: 10.1080/02643290802106415
Williams, R.M. (2020). Falsified incompetence and other lies the positivists told me, Canadian Journal of Disability Studies, 9:5, 214-244 DOI: h10.15353/cjds.v9i5.696
Hills, K., Clapton, J., Dorsett, P., & Andersen, K. (2020). Conducting research with people with nonverbal autism: An inclusive methodological approach, Journal of Social Inclusion, 11:1 DOI: 10.36251/josi.162
Mintz, K. (2017). Ableism, ambiguity, and the Anna Stubblefield case, Disability & Society, 32:10, 1666-1670 DOI: 10.1080/09687599.2017.1356058
Woodfield, C., & Ashby, C. (2016). ‘The right path of equality’: supporting high school students with autism who type to communicate, International Journal of Inclusive Education, 20:4, 435-454
Bennett, A. (2011). "Freedom herself is very agile, very co-dependent, and a lovely person": The School identities of high school aged youth with communication differences, Disability Studies Quarterly, 31.
Erevelles, N. (2002). Voices of Silence: Foucault, Disability, and the Question of Self-determination, Studies in Philosophy and Education, 21:17-35 DOI: 10.1023/A:1014473121819
Olney, M.F. (2001). Evidence of Literacy in Individuals Labeled with Mental Retardation, Disability Studies Quarterly, 21:2
Jaswal, V.K., & Akhtar, N. (2019). Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism, Behavioral and Brain Sciences, 42, e82: 1-73 DOI: 10.1017/S0140525X18001826
Our detailed critique of Jaswal & Akhtar (2019) is here.
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Welch, C., Polatajko, H., Rigby, P., & Fitch, M. (2019). Autism inside out: Lessons from the memoirs of three minimally verbal youths:19, 2308-2316 DOI: 10.1080/09638288.2018.1465133
Ochs, E., Solomon, O., and Sterponi, L. (2005). Limitations and transformations of habitus in Child-Directed Communication. Discourse Studies, 7:(4-5), 547-583. DOI: 10.1177/1461445605054406
Critique: none of these articles provide any evidence that shows that FC/RPM/S2C is a valid mode of communication.
Articles that treat FC as a form of AAC
Pro-FC websites often present FC as a form of AAC, intermixing information and articles about AAC with pro-FC content. The “Research” page of one FC website contains over two dozen articles about AAC, most of which make no mention of FC.
Two of these articles recount the history and current status of AAC, but make no mention of FC:
McNaughton, D., & Light, J. (2015). What we write about when we write About AAC: The past 30 years of research and future directions. Augmentative and Alternative Communication, 31:4, 261-270. DOI: 10.3109/07434618.2015.1099736
Iacono, T., Trembath, D., & Erickson, S. (2016). The role of augmentative and alternative communication for children with autism: current status and future trends. Neuropsychiatric Disease and Treatment, 12: 2349–2361. DOI: 10.2147/NDT.S95967
One of these articles, however, explicitly treats AAC as a form of FC:
Ashby, C., & Kasa, C. (2013). Pointing forward: typing for academic access, Perspectives on Augmentative and Alternative Communication, 22: 143-156 DOI: 10.1044/aac22.3.143
One article discusses the role of the assistant when interacting with individuals using augmentative and alternative communication (AAC). It includes explicit guidelines for fading of prompts, including complete prompt fading and user independence before the end of the instruction phase and post-testing.
Kent-Walsh, J., & McNaughton, D. (2005). Communication Partner Instruction in AAC: Present Practices and Future Directions. Augmentative and Alternative Communication, 21 (3), 195-204. DOI: 10.1080/07434610400006646
General commentary: Legitimate AAC—which includes sign language, Picture Exchange Communication System or PECS, and high-tech picture/icon speech generating devices—does not raise concerns about facilitator influence. In autism, AAC use does not require a designated facilitator to hold up a device or sit within cueing range of the AAC user.
Articles that discuss prompts and prompt fading
Some proponents of FC have tried to compare the prompting used in FC with that used in evidence-based interventions like ABA. The Research page of one pro-FC site, for example, includes this article:
Cengher, M., Budd, A., Farrell, N., & Fienup, D. (2018). A Review of Prompt-Fading Procedures: Implications for Effective and Efficient Skill Acquisition, Journal of Developmental and Physical Disabilities, 30:155-173
Commentary: This article makes no mention of any form of FC. In evidence-based therapies, prompts are faded as quickly as possibility and guidelines include protocols for avoiding inadvertent cuing. In FC, prompts may be faded, and inadvertent cues may become more subtle over time, but there is no evidence of FC users who achieve the ability to type messages that match the sophistication of their facilitated messages in situations where all facilitator cues have been unequivocally faded.
Articles that find evidence for (sensory) motor difficulties in autism
A large amount of research has found evidence for motor and sensory processing difficulties in autism, and these are routinely cited by FC proponents.
A recent systematic review reports numerous findings about gross motor impairment in particular.
Wang, L.A.L., Petrulla, V., Zampella, C.J., Waller, R., & Schultz, R.T. (2022). Gross motor impairment and its relation to social skills in autism spectrum disorder: A systematic review and two meta-analyses. Psychological Bulletin, DOI: 10.1037/bul0000358
Commentary: This review and analysis finds evidence for challenges like balance, gait, postural control, throwing a ball, and coordination between right and left limbs. None of this has any apparent connection to FC.
Other articles have found evidence for fine-motor challenges like grasping and penmanship, for example this one, which focuses on grasping difficulties in 18-36-month-old children at risk for autism:
Focaroli, V., Taffoni, F., Parsons, S.M., Keller, F., & Iverson, J.M. (2016). Performance of motor sequences in children at heightened vs. low risk for ASD: A longitudinal study from 18 to 36 months of age, Frontiers in Psychology, 7:724 DOI: 10.3389/fpsyg.2016.00724
Other articles find evidence for sensory-processing difficulties in autism, for example:
Chang, Y.S., Owen, J. P., Desai, S.S., Hill, S.S., Arnett, A.B., Harris, J., Marco, E.J., & Mukherjee, P. (2014). Autism and sensory processing disorders: shared white matter disruption in sensory pathways but divergent connectivity in social-emotional pathways, PloS One, 9:7, e103038 DOI: 10.1371/journal.pone.0103038
Some articles report difficulties with motor planning or dyspraxia, for example:
MacNeil, L.K., & Mostofsky, S.H. (2012). Specificity of dyspraxia in children with autism, Neuropsychology, 26:2, 165-171 DOI: 10.1037/a0026955
This article finds that children with autism had difficulty, compared to children with ADHD, in performing skilled gestures in the response to verbal commands, prompts to imitate the gesture, and prompts involving tools to be used.
Commentary: None of these findings about (sensory) motor difficulties in autism explain why autistic individuals can only point to the letters on keyboards/letterboards and spell out meaningful messages when someone provides physical support (as in traditional FC) or holds up the board (as in RPM/S2C).
Articles that collectively argue that autism is fundamentally a motor disorder rather than a socio-cognitive disorder
FC-proponents emphasize motor/motor planning difficulties in autism not just to account for the need for the physical support/held-up boards/verbal prompting of FC/RPM/S2C, but also to advance a redefinition of autism: a definition that fits better with some of the otherwise hard-to-explain phenomena surrounding facilitated communication. These phenomena include the sudden emergence of language, literacy, and worldly knowledge from individuals whose outward behaviors show little signs of paying attention or of linguistic comprehension.
If autism is a motor disorder, then autistic individuals only look like they’re not paying attention, not interested in pointing to objects of interest, and not able follow verbal commands. Instead, what’s purportedly going on is that their motor control problems prevent them from tracking things with their eyes, executing pointing gestures, and moving their bodies on command. If autism is merely a motor disorder, then there’s theoretically nothing preventing autistic individuals from picking up language and information about the world simply by listening and looking, however atypical those listening and looking behaviors might appear. Finally, if autism is a motor disorder, and if autistic individuals are sufficiently sponge-like in their absorption of information from the environment, then the sophisticated vocabulary, perfect spelling, and surprising erudition that often emerges shortly after facilitation begins look less like red flags of implausibility, and more like the realization of people’s hopes and dreams.
This section provides a brief review of articles that attempt to redefine autism as a movement disorder and/or argue that autism is not a socio-cognitive disorder, and/or argue that language skills, cognitive skills, and/or literacy skills are intact.
1. Autism as a movement disorder
Torres, E.B., & Donnellan, A.M., eds. (2013-2015). Autism: The movement perspective (2013-2015). Frontiers in Integrative Neuroscience.
This series includes the following articles:
Torres, E.B., & Donnellan, A.M. (2015, March 16). Editorial for research topic “Autism: the movement perspective”. Frontiers in Integrative Neuroscience. DOI: 10.3389/fnint.2015.00012
Johnson, B., Rinehart, N., Papadopoulos, N., Tonge, B, Millist, L., White, O., and Fielding, J. (2012, November 7). A closer look at visually guided saccades in autism and Asperger’s disorder. Frontiers in Integrative Neuroscience. DOI: 10.3389/fnint.2012.00099
Braadbaart, L., Waiter, G., and Williams, J. (2012, October 16). Neural correlates of individual differences in manual imitation fidelity. Frontiers in Integrative Neuroscience. DOI: 10.3389/fnint.2012.00091
Critique: These articles do not provide convincing counterarguments to the body of evidence for autism as a socio-cognitive disorder, nor do the movement impairments they discuss provide an alternative account of all the core behavioral symptoms of autism.
Gernsbacher, M. A., Sauer, E. A., Geye, H. M., Schweigert, E. K., & Goldsmith, H. H. (2008). Infant and toddler oral- and manual-motor skills predict later speech fluency in autism. Journal of Child Psychology and Psychiatry, 49, 43-50. DOI: 10.1111/j.1469-7610.2007.01820.x
Critique: This article argues that speech delays in autism are due to motor delays, but the articles they cite do not back them up, and their own experiment conflates motor delays with issues of social engagement. Our more detailed critique is here.
2. Autism as not involving social deficits
Gernsbacher, M. A., & Frymiare, J. L. (2005). Does the autistic brain lack core modules? The Journal of Developmental and Learning Disorders, 9, 3–16.
Our critique of Gernsbacher & Frymiare (2005) is here.
Critique: This article overlooks (1) some of the limitations on the ability of autistic individuals to infer the beliefs of other people (2) the social consequences of the aversion to eye contact.
Gernsbacher, Sauer, Geye, Schweigert, and Goldsmith (2008). Why does joint attention look atypical in autism. Child Development Perspectives, 2(1), 38–45. DOI: 10.1111/j.1750-8606.2008.00039.x
Critique: The authors attempt to argue that reduced Joint Attention in autism results from motor impairments that impede gaze shifting and pointing, but the research they cite does not support them. For our more detailed critique, see here
Akhtar, N., & Gernsbacher, M. A. (2008). On Privileging the Role of Gaze in Infant Social Cognition. Child development perspectives, 2(2), 59–65. DOI: 10.1111/j.1750-8606.2008.00044.x
Critique: This article argues that there are other ways to engage with people and respond to bids for Joint Attention than via eye gaze. However, the authors do not supply any evidence that individuals with autism compensate for reduced their reduced eye contact via these other methods. The authors also overlook the special role played by eye gaze following in implicit language learning. For a more detailed critique, see here.
Gernsbacher, M. A., & Pripas-Kapit, S. R. (2012). Who's Missing the Point? A Commentary on Claims that Autistic Persons Have a Specific Deficit in Figurative Language Comprehension. Metaphor and symbol, 27(1), 93–105. https://doi.org/10.1080/10926488.2012.656255
Critique: This article argues that difficulties with figurative language are the result only of language delays and not of socio-cognitive deficits. The authors overlook how difficulties with figurative language also stem from autism-related deficits in joint attention, in social inferencing, in using broader context in text inferencing, and in socially learned worldly background knowledge. The article also proposes that the higher-level empathy deficits in autism merely reflect the challenges of figuring out what to do in a broader culture that is dominated by a non-autistic majority. But it fails to make a case for a minority autistic culture in which autistic individuals have no difficulty with empathy. For detailed critiques on each of these arguments, see here and here.
Gernsbacher, M. A., & Yergeau, M. (2019). Empirical Failures of the Claim That Autistic People Lack a Theory of Mind. Archives of scientific psychology, 7(1), 102–118. DOI: 10.1037/arc0000067
Critique: This authors overlook numerous findings—even in the articles that they themselves cite—concerning significant limitations in the ability of autistic individuals to infer, and act appropriately on, the emotions and beliefs of other people, particularly in naturalistic, real-world settings. For detailed critiques of this article, see here, here, here, here, here, and here.
Jaswal, V.K., & Akhtar, N. (2019). Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism, Behavioral and Brain Sciences, 42, e82: 1-73. DOI: 10.1017/S0140525X18001826
Critique: A substantial part of the authors’ evidence base comes from testimonials obtained through facilitated communication. The authors discuss how aversion to eye contact may not reflect a lack of social interest, but fail to consider how low eye contact impedes social learning. The authors fail to provide convincing evidence for the kinds of motor problems that would explain the infrequency of pointing by autistic children.
3. Autism as not involving linguistic deficits or linguistic idiosyncrasies
Bara, B.G., Bucciarelli, M., & Colle, L. (2001). Communicative abilities in autism: Evidence for attentional deficits, Brain and Language, 77: 216-240. DOI: 10.1006/brln.2000.2429
Critique: This article finds that a sample of non-speaking autistic children performed as well as the control group of typically developing children in comprehending complex language, inferring communicative intent, and understanding other people’s mental states. But the performance of the autistic participants on all of these tasks was based on output generated by facilitated communication.
Akhtar, N., & Gernsbacher, M. A. (2007). Joint attention and vocabulary development: A critical look. Language and linguistics compass, 1(3), 195–207. DOI: 10.1111/j.1749-818X.2007.00014.x
Critique: This article argues that Joint Attention is not necessary for word learning—and, by implication, that the Joint Attention deficits in autism do not impede language acquisition. But the authors use a narrower definition of Joint Attention than what applies in the research that connects Joint Attention to word learning. The authors cite other research that finds no connection between Joint Attention and word learning, but that research also restricts itself to a less relevant sub-variety of Joint Attention. Our detailed critique of this article is here.
Gernsbacher, M.A., Morson, E. M., & Grace, E. J. (2015). Language development in autism. In G. Hickok & S. L. Small (eds.) Neurobiology of Language, 879-886. Academic Press. DOI: 10.1016/B978-0-12-407794-2.00070-5
Critique: The authors claim that some studies “have not shown that autistic language development differed from typical language development,” but none of the studies they cite support this claim. Some of the studies only present results for those with High Functioning Autism/Asperger’s, where language development is closer to typical; many of the studies emphasize the specific difficulties that autistic individuals have with comprehension. Our detailed critique of this article is here.
Gernsbacher, M. A., Morson, E. M., & Grace, E. J. (2016). Language and speech in autism. Annual Review of Linguistics, 2, 413–425. DOI: 10.1146/annurev-linguist-030514-124824
Critique: The authors argue that pronoun reversals, echolalia, and a smaller-than-to-be-expected lag between comprehending language and producing it are not specific to autism. But they overlook findings that pronoun reversals and echolalia are much more common in autism than in non-autistic populations. And they overlook findings that higher-level comprehension is especially impaired. Our detailed critique of this article is here.
4. Average to superior cognitive skills in minimally-speaking autism
Regarding under-estimated cognitive ability, many researchers note, correctly, that it can be extremely difficult to assess cognitive ability in minimally-verbal individuals, as language limitations may affect comprehension of cognitive tasks, even non-verbal cognitive tasks that are not supposed to be measuring language. Those studies that do find ways to measure performance on non-verbal tasks, however have found average-to-superior skills in certain types of tasks—particularly visual-spatial tasks like the Raven’s Progressive Matrices. A recent such article is:
Courchesne, V., Meilleur, A.-A.S., Poulin-Lord, M.-P., Dawson, M., & Soulières, I. (2015). Autistic children at risk of being underestimated: school-based pilot study of a strength-informed assessment, Molecular Autism, 6:12. DOI: 10.1186/s13229-015-0006-3
Commentary: Intact non-verbal intelligence, well-established in autism, is only loosely correlated with verbal intelligence. Verbal intelligence (language skills in particular) is crucial for knowledge acquisition: most knowledge is learned through reading and listening. Good performance on Raven’s Progressive Matrices does not account for the language, literacy, and general knowledge skills displayed through facilitated communication.
5. Hyperlexia in autism
Also long recognized in autism is hyperlexia, or a precocious interest in letters and numbers, and a precocious ability to recognize printed words. One recent article is:
Ostrolenk, A., Forgeot d’Arc, B., Jelenic, P., Samson, F., & Mottron, L. (2017). Hyperlexia: Systematic review, neurocognitive modelling, and outcome, Neuroscience & Biobehavioral Reviews, 79, 134-149. DOI: 10.1016/j.neubiorev.2017.04.029
Commentary: Only about 5-10% of the autistic population are known to be hyperlexic. There is no evidence that most facilitated individuals are hyperlexic. Hypermedia is also associated with delayed comprehension. For facilitated messages to count as authentic communications, the authors of the messages must not only recognize the words in those messages, but also understand what they mean.
6. Speech skills vs. written language skills in autism
FC proponents also frequently point out that speech is not the same as language. One pro-FC website includes this article:
Finkl, T., Hahne, A., Friederici, A.D., Gerber, J., Mürbe, D., & Anwander, A. (2020). Language without speech: segregating distinct circuits in the human brain, Cerebral Cortex, 30(2): 812-823. DOI: 10.1093/cercor/bhz128
Commentary: This article observes, correctly, that different neural circuitry is involved in processing and learning speech, as opposed to that involved in processing and learning visual languages like sign language. But this doesn’t mean that spoken English and typed English are different languages, or that all the neural circuitry involved is distinct. A child who doesn’t understand spoken English is unlikely to get very far making sense of written language—beyond a few printed words that label concrete objects.
Articles that find that standard treatments are ineffective
FC proponents also routinely note the failure of standard interventions, particularly with non-speaking and minimally-speaking individuals. First and foremost among these is:
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum, Autism Research: Official Journal of the International Society for Autism Research, 6:6. DOI: 10.1002/aur.1329
Commentary: The fact that other treatments have been minimally effective with some populations does not justify the use of non-evidence based treatments. In a different context (major depression), the “nothing else works” line of reasoning was once used to justify frontal lobotomies.