Supplement to the “Anatomy of Facilitated Communication” SkeptiCal Talk
On July 17, 2022, I gave a talk for Skeptical 2022 called “Anatomy of Facilitated Communication: How to Spot Cuing in FC.”
The goal of the talk was to teach people how to spot facilitator cuing. As with all my critiques of Facilitated Communication (FC), my criticism refers to the technique and not to the individuals being subjected to it.
FC is also known as Rapid Prompting Method (RPM), Spelling to Communicate (S2C), Supported Typing (ST), Typing to Communicate, Informative Pointing, Hand-Over-Hand, Assisted Typing, Speaking with Eyes and others. What matters isn't the latest brand name, but the issue of facilitator control, and our focus should be on on the behaviors of the facilitators to determine the presence of facilitator cuing.
Cuing can be inadvertent, especially with touch-based forms of FC. It is possible that facilitators may not consciously be aware of the extent to which they cue their clients. However, newer variants of FC (e.g., S2C) appear to employ hand signals in addition to more subtle cuing (e.g., waving a board in the air, changing body position or altering vocal inflections). These hand signals appear to be deliberate and seemingly more purposeful.
Regardless of the name facilitators are using for FC, their behavior equals Facilitator Control, and individuals with profound communication difficulties deserve to have access to legitimate Augmentative and Alternative Communication (AAC) for independent, not facilitated, communication.
Anatomy of Facilitated Communication: How to Spot Cuing in FC. Skeptical (July 17, 2022)
Alternative Names for FC (the list keeps growing)
Supported Typing, Saved by Typing, Facilitated Communication Training, Informative Pointing, Spelling/Communication Therapy, Rapid Prompting Method, Spelling to Communicate, Assisted Typing, Letter Boarding, Supported Decision Making, Hand-Over-Hand, Speaking with Eyes, Motor Communication, Intuitive Pointing, Spelling on an iPad, Motor-Based Communication Techniques.
Studies and Resources to Learn More About FC
Clever Hans: It’s Not About the Horse
Systematic Reviews and Controlled Studies
Image by Giulia May
Links to Video Clips
QWERTY - Linsey Polka, Peter Rowe, Terri Delaney. (YouTube, Rufus Lane, 2009)
The Reason I Jump (Film) (2020)
No More! No More! (Review of an FC session featured in The Reason I Jump)
Facilitated Communication - “I Would not get to this stage if I did not get full support initially” (YouTube, Communication Rights, 2011)
Jonathan Bryan - The Boy Who Speaks with His Eyes (YouTube, Department for International Development, 2018)
Autism Society Talk - Coronavirus Information - Coping with COVID-19 Through the Arts (Facebook Zoom Call with individuals using S2C/RPM, 2021)
Matthew Cramer: An Autistic teen’s story of learning with a letter board. Movers & Makers (WHYY, 2022)
Deej Q&A with David “DJ” Savarese (YouTube, ReelAbilities Film Festival: New York, 2018)
Autism is a World (Film) (Vimeo, GAMP, 2014)
Some of the Ways Facilitators May Cue Their Clients (note: not every facilitator employs all of the cues)
Physical Touch
Facilitator eye contact with the board (while their client does not look)
Rapid typing - too rapid for processing which letters are touched
One finger, hunt-and-peck typing
Holding the Board in the Air
Use of Hand Signals
Ignoring Client Verbal and Non-Verbal Communication
Facilitator controls when the individual interacts with the communication device
Uses fingers and palm of hands to apply pressure on an individual’s shoulder or other body part
Moves the letter board for optimal letter selection
Traps the person in a corner to force participation
Controls the start and stop of the typing session
Presumes visual acuity and eye movement/tracking ability in the client
Calls out letters not touched by the individual
Shifts body weight
Types answers to questions known to the facilitator but unlikely to be known by the individual being subjected to FC
Talks for the person without the individual speaking, signing, writing, or typing a response
Choosing for the individual which communication system to use
Allowing standardized tests (e.g., IQ) to be taken with facilitator cuing and not independently
Pinches, pushes, lightly kicks or taps with a foot, or otherwise physically handles the individual to gain attention when signaling to select or deselect a letter on a letter board.
Other Indicators that May Signal Facilitator Influence (note: not all these indicators are evident with every facilitator)
Claims of unexpected literacy skills
Claims the client can type using peripheral vision or without looking at the board
Lack of Joint Attention (e.g., client is not paying attention to the facilitator or surroundings)
Unwillingness to allow the client to type without the facilitator present (e.g., within visual and auditory range)
Unwillingness to participate in activities in which the client knows the content to be discussed but the facilitator does not.
Alternative names for “facilitator” are used: communication assistant, support assistant, communications and regulations partner, interpreter.
The typed message is different than the verbal and non-verbal behaviors of the individual being facilitated.
For individuals with some verbal skills: the individual cannot read back what was just typed.
The individual cannot identify letters or the sounds of letters when asked (outside the presence of a facilitator).
The individual can read words but without comprehension (e.g., hyperlexia)
Dramatic changes in I.Q. scores with and without facilitation (e.g., a shift from 29 to 133)
Use of anecdotes and testimonials as “proof” FC works (e.g., FC works because people using FC say it works)
Limited or no eye movement of client during the typing activity (e.g., little or no tracking from left to right or whatever direction the written system is set up)
Image by Meghan Schiereck
Questions Facilitators Don’t Want You To Ask
Who is controlling the typing?
Why is the board moving in the air?
Why does it look like you’re moving the client’s hand?
How can the individual type accurately with one finger if they aren’t looking?
Is there reliably controlled evidence to back up your claims of independent communication?
Aren’t you building dependence on the facilitator instead of independence for the individual being subjected to FC?
What is the impact on the lives of individuals with profound communication difficulties if and when the facilitated messages are not their own?
Do the professional organization(s) you are affiliated with have policies regarding FC/S2C/RPM. (Opposition Statements available here)
Is there standardized licensing and training for FC/S2C/RPM?
How is the client’s quality of life and autonomy impacted when the facilitator ignores or downplays their verbal and non-verbal communications and favors the facilitator-dependent, typed ones?
Who is completing the coursework when FC/S2C/RPM are used in mainstreamed elementary and high school classes or at universities? The student? Or the Facilitator?
When pre-programmed answers are used to answer questions in class, who typed the answers into the communication device?
It’s one thing to have an individual press a single button to activate a communication device, but can the individual spell independently? Write sentences? Understand and process complex spoken and written language?
What happens to the student’s understanding of coursework if a facilitator unfamiliar with the class content assists with the exams?
What happens to the individual’s ability to type when the facilitator is out of visual and auditory range?
What are the professional and ethical ramifications for facilitators who use and promote discredited, unproven, disproven techniques?
Have you been informed that false allegations of abuse may occur through facilitator-generated messages? (See False Allegations)
What if facilitators override the verbal and non-verbal communications of the individual and initiate unwanted relationships? (See Facilitator Crimes)
What are we saying as a society about the value of individuals with profound disabilities if we allow FC to continue untested?
Why do facilitators continue to rebrand FC and avoid reliably controlled testing?
What are the obstacles to people speaking out against FC/S2C/RPM?
Why do facilitated individuals appear to defy how language and literacy skills are learned?
What are the facilitator’s behaviors during the typing activity? Are they contributing to letter selection and/or interfering with the communication process?
Are there evidence-based communication (AAC) techniques and methods that the client can use instead?
Is using discredited, pseudoscientific techniques on individuals with profound communication difficulties a violation of their human rights?
The only thing that changes in the facilitator-client relationship under blinded testing is the facilitator doesn't have access to test protocols. Everything else stays exactly the same. If the client is communicating independently, why should this be a problem?