Critiques of Pro FC Articles
Proponents of FC claim that the process of facilitation is either too complex to test or that the accuracy of FC-generated messages deteriorates under “stressful” conditions. Some accuse their clients of purposefully undermining the test setting by lying or joking around when inaccurate answers and actively avoid activities in which the facilitators are blinded from the development and administration of test protocols. They claim that qualitative testing (e.g. observation, parental and educator interviews) can accurately answer the question of authorship while eschewing the only reliable way to determine it: blinded testing. The following articles appear on proponent lists as positively supporting FC. Any critiques offered are just starting points. We encourage readers to further explore the integrity of the articles, including evaluating methods and citations used in the individual studies.
2024
Okoli, I., Olson J. N., & Adekanye, B. (2024). Interventions to Redirect Behaviors and Improve Learning in Non-Speaking Autistic Individuals: An Exploratory Analysis of the Rapid Prompting Method (RPM). Autism Open-Access 14(2).
This pro-RPM study finds the longer people are subjected to RPM, the more accurate their RPM-generated responses to questions. However, this does not count as evidence for the validity of RPM: all it shows it that cueing and prompting in RPM shapes behavior over time—whether or not one actually learns anything useful/meaningful. Only a controlled message-passing test would establish validity for RPM; no such tests have been published.
2022
Heyworth, M., Chan, T., & Lawson W. (2022). Presuming autistic communication competence and reframing facilitated communication. Frontiers in Psychology.
Critique: The authors base their argument on several dozen problematic claims and assumptions:
Inaccurate assumptions about augmentative and alternative communication (AAC), Applied Behavior Analysis (ABA), conversational pragmatics, message passing tests, cognitive testing, cueing, recent discoveries about autism, and/or the empirical research on FC.
Claims based on circular reasoning
Claims that are not supported by the studies cited as support.
Biased characterizations of FC critics
Biased takes on key concepts pertaining to FC and the rights of people with disabilities.
This article is reviewed here:
Beals, Katharine (2022, July 22nd). Why we should not presume competence and reframe facilitated communication: a critique of Heyworth, Chan & Lawson. Evidence-Based Communication Assessment and Intervention, DOI: 10.1080/17489539.2022.2097872
2021
Faure, Patrick, Legou, Thierry, and Gepner, Bruno. (2021, January 14). Evidence of Authorship on Messages in Facilitated Communication: A Case Report Using Accelerometry. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2020.543385
This article is a case study of one individual and one facilitator using accelerometry to determine the motor contribution of the typing duo during facilitated communication.
Critiques:
The authors claim Facilitated Communication is a form of Augmentative and Alternative Communication (AAC), which it is not. To be recognized as AAC, a method and technique must be used by the individual without interference from an assistant or facilitator. See Opposition Statements for more information.
Proven AAC devices already exist that allow individuals to interact with the devices without interference from facilitators. These can be adapted for stabilization and response times for individuals with physical impairments far more extensive than those generally seen in individuals with autism and are recommended over discredited and/or unproven techniques like FC and RPM.
The authors mischaracterize the activity as an authorship study, without blinding the facilitator to test protocols. The information provided included information the individual could already type on his own, begging the question of why he needed a facilitator in the first place. The speed and accuracy of the responses when two people are typing together does not and cannot determine independent authorship. The two are inextricably linked. See Controlled Studies for more information.
The conclusion of the study, that the individual and the facilitator influenced the movements at varying rates, depending on where the support was provided - wrist, elbow, or shoulder - proves nothing about authorship and reveals what is already known: that when a facilitator touches the individual, the movements are influenced to varying degrees by that touch. Individuals are, essentially, taught to point on cue with FC and RPM. See the Ideomotor Response for more information.
The only reliable response given were when the individual typed by himself at 100% accuracy.
In the history of FC provided, the authors failed to mention that false allegation of abuse cases did not originate in the U.S., but with Rosemary Crossley and eight of her facilitators in Australia. See False Allegations for more information.
2020
Jaswal, V.K., Wayne, A. & Golino, H. (2020) Eye-tracking reveals agency in assisted autistic communication. Scientific Reports 10, 7882. DOI: 10.1038/s41598-020-64553-9
Head-mounted eye-tracker used to investigate communicative agency in nine nonspeaking autistic individuals using Spelling To Communicate—a variant of facilitated communication in which the facilitator holds up the letterboard. Participants pointed to about one letter per second and visually fixated most letters about half a second before pointing to them.
Critiques:
Proponents claim this study is not about RPM, even though the facilitator holds the board in the air and the activity is described as “letter boarding.” It also appears on proponent lists of “RPM-Related Literature.” In their statement opposing RPM, ASHA identifies alternative names used by proponents and emphasizes facilitator behavior as a key to identifying its use.
RPM is not recognized as a legitimate form of Augmentative and Alternative Communication (AAC) by organizations opposing its use. The issue is not with the use of AAC or assistive communication for nonspeaking individuals with autism, but with the use of unproven and discredited methods and techniques that, demonstrably, build dependence on the facilitator, rather than independence.
Rather than have the letter board mounted for stability, the facilitator held the board, raising concerns of inadvertent movements by the facilitator. Such movements may have influenced the apparent targets of finger points and eye gazes.
The assistant/facilitator was not blinded to test protocols, raising concerns about inadvertent influence and control.
Eye gazing technology is currently available that allows individuals to interact with the device independently and communicate their own thoughts without the interference of a facilitator. Pairing RPM or letter boarding with eye gazing technology undermines the efficacy of this legitimate form of AAC.
Successful independent use of AAC by individuals with profound physical disabilities not generally seen in individuals with autism calls into question why the facilitator is required to hold onto the letter board. These technologies and methods can be adapted to meet the stabilization needs of individuals with varying degrees of physical, even unpredictable, movement.
This article is reviewed in the following:
Beals, Katharine (2021, May 12). A Recent Eye-Tracking Study Fails to Reveal Agency in Assisted Autistic Communication. Evidence-Based Communication Assessment and Intervention, DOI: 10.1080/17489539.2021.1918890
Beals, Katharine. (2020, December 11). What Scientific Reports Won’t Publish. My Critique of Jawal’s FC/S2C Eye Tracking Study. Catherine and Katharine: Writing and Reading From the Sentence Up.
London, W. (2021, September 26). Facilitated Communication Validation Study Criticized. Consumer Health Digest. Issue 21-38.
Vyse, Stuart. (2020, May 20). Of Eye Movements and Autism: The Latest Chapter in A Continuing Controversy. Skeptical Inquirer.
McKee, A. and Gomez, A. (2020). The Voices of Typers: Examining the Educational Experiences of Individuals who Use Facilitated Communication. Disabilities Studies Quarterly. 40 (4).
“In this qualitative study, interviews with eight autistics who type using the method facilitated communication are analyzed in relation to their educational experiences.”
Critiques:
FC is described in the article as an alternative communication method using a facilitator as a “tool,” similar to other forms of mediated communication such as writing utensils and cell phones. The facilitator “should not lead the individual.” However, even though independence is the intent, it “does not necessarily happen in every situation.” In fact, controlled studies show that there is no evidence that independent communication has ever been achieved using FC.
The article describes FC as a legitimate form of Augmentative and Alternative Communication (AAC). However, the American Speech-Language-Hearing Association (ASHA) and others oppose the use of FC and RPM because these techniques build dependence upon the facilitator, not independence. Current evidence-based methods and technologies exist that allow individuals with disabilities to interact with communication devices without the interference of a facilitator.
This study used a qualitative approach (e.g., semi-structured interviews) to determine participant experiences using FC. That means no controls were put in place to determine facilitator influence or control over authorship. An assumption was made that FC already “worked” for the individuals. Messages obtained and included in the article, therefore, should be viewed as those of the facilitators and not of the individuals being facilitated.
2016
McQuiddy, V. and Brennan, A.M. (2016). Occupational Therapy using Rapid Prompting Method: A Case Report. Autism Open Access. 6, 1. DOI: 10.4172/2165-7890.1000165
This case study documents the incorporation of Rapid Prompting Method into an occupational therapy treatment for a young adult male with autism and significantly limited verbal ability.
Critiques:
Rapid Prompting Method, to date, has no reliable evidence that messages obtained using the technique are those of individuals with disabilities. Rather, its shared characteristics with Facilitated Communication (e.g., prompt dependency and facilitator cuing) have lead organizations such as ASHA and AAIDD to develop position statements opposing its use. Cuing, often attributed to the ideomotor response, or non-conscious muscle movements, is evident even without physical touch and often is visibly evident as facilitators hold letter boards in the air.
Despite claims in the report to the contrary, independent language and literacy skills can only be determined through controlled testing in which the facilitator is blinded to test protocols. Test scores in which the typing activity is shared and the facilitator is not blinded to the content cannot be reliably attributed to independent communication. On the contrary, based on controlled FC studies, facilitator control over the messages is much greater than chance.
It is possible that OT directed exercises helped the participant stay seated, attend to the lessons longer, and point with more accuracy, but none of these by themselves prove an increase in language and literacy skills.
Consumer-ready technology already exists that allow individuals with severe communication and motor difficulties to interact with the communication devices without the interference of an assistant or facilitator.
Broderick, A., & Kasa-Hendrickson, C. (2016). “Say Just One Word at First”: The Emergence of Reliable Speech in a Student Labeled with Autism. Research and Practice for Persons with Severe Disabilities, 21(1), 13-24.
Critiques:
The short sampling of the student’s speech provided in the article is not enough to gauge his abilities.
The student’s speech mostly amounts to reading aloud the words he typed through facilitated communication after they were typed out. But people can decode words they don’t understand and pronounce messages they didn’t author.
The student occasionally got stuck while reading and relied on auditory cues from his mother.
The authors and his mother report that at least some of his “spontaneous” speech is merely echolalic.
The authors claim that the student’s typing is independent but also concede that “independence” can involve “minimal support” (e.g., touch from the facilitator on the back of the neck or shoulders).
The authors collaborated with Douglas Biklen, founder of the Facilitated Communication Institute at Syracuse University, to produce a documentary which showcases this student and shows him being touched at the wrist, forearms, elbows, and shoulders by his facilitators while he extends pointer fingers toward the keyboard.
For a more detailed critique, see Janyce’s blog post here.
2015
Ashby, C., Jung, E., Woodfield, C., Vroman, K., and Orsati, F. (2015). ‘Wishing to go it alone’: the complicated interplay of independence, interdependence and agency.’ Disability and Society. 30 (10), 1474-1489. DOI: 10.1080/09687599.2015.1108901
This article uses a Disability Studies lens to “frame practices around independence and the complicated interplay between interdependence, agency and voice.” The findings are based on qualitative analyses of communication training sessions.
Critiques:
The article is based on the premise that facilitated communication works and the messages obtained using this technique is proven to be independent. It is not. There are no reliable, high-quality controlled studies that demonstrate the messages are typed solely by the individual with disabilities. In fact, it has been demonstrably proven that facilitators and not the people being facilitated who are controlling the written output. Qualitative measures (e.g., interviews, observations, analysis of written output) fail to address the issues of authorship and agency.
The authors define “independence” as a dependent relationship between the facilitator and the person being facilitated. Communication happens with FC because the facilitator provides verbal, physical, and visible cuing. These cues are built-in to FC and cannot be “faded.” Altering the amount of support from the wrist to the shoulder does not eliminate facilitator cuing. With practice, the cues simply become more subtle. Cuing is also evident even when the individual is not being physically touched but the facilitator is holding a letter board. Remove the facilitator from visual and auditory range of the individual being facilitated and the written output degenerates, sometimes to the point of intelligibility. Agency, in the case of FC, belongs to the facilitator and not to the individual being facilitated. Truly independent communication (e.g., thought of and composed solely by the individual with disabilities) cannot be achieved with FC.
As the authors state, “Independence is a stated goal in all training workshops for facilitated communication; the work of fading support can begin at any time and should continue throughout the process of developing skills to communicate through typing.” But, again, fading is integral to how FC works. There is no set standards or timelines for expected fading and individuals using FC have relied on facilitator support, now, for decades. Levels of support have no bearing on the amount of cuing the facilitator provides and fading, to date, has not been reliably proven to be anything but an empty goal on a piece of paper.
Consumer-ready technology currently exists to allow individuals requiring “intensive physical support” to interact with communication devices independently and without interference from a facilitator. Adjustments can be made for diminished motor ability, tremors, eye tracking anomalies, and more. Low and high-tech equipment is available. The need for a facilitator is obsolete.
Proponents of facilitated communication claim FC works because people using FC say it works. ASHA, AAIDD, APA, ISAAC, and other organizations have opposition statements in place because of the lack of evidence regarding independence, facilitator controls, false allegations of abuse, and facilitator crimes. Because of facilitator control, the FC-generated messages cannot be relied upon as representations of the thoughts and feelings of individuals with disabilities. Instead, they are the thoughts and feelings of the facilitators who control the messages. Agency, independence, self-expression, self-actualization are all important issues to be discussed in regards to individuals with disabilities and their right to independent communication. Proponents of FC, though perhaps well-meaning, strip individuals of these communication rights by preventing individuals from accessing evidence-based communication methods and techniques and building a communication system based solely on facilitator input.
2014
Cardinal, D., & Falvey, M. (2014). The Maturing of Facilitated Communication: A Means Toward Independent Communication.
Research and Practice for Persons with Severe Disabilities, 39:3, 189-194. 10.1177/1540796914555581
The authors of this review paper posit that facilitated communication can be a successful means for people to learn to communicate effectively and independently and claim researchers have produced a body of current literature confirming the method.
Critiques:
The authors equate quantity with quality of research, putting more stock in qualitative (e.g., ethnographic, observational studies) than quantitative (e.g., controlled, evidence-based studies). Test controls are not valued as a means of determining authorship.
Proof of efficacy comes in the form of circular reasoning: individuals using facilitated communication say FC “works,” so, therefore, it must be valid.
Wilson, M., de Jonge, D., de Souza, N., and Carlson, G. (2014, January). Facilitated Communication Training: Exploration of perceptions of ability and reducing physical support. Disability Studies Quarterly. 34 (1). DOI: http://dx.doi.org/10.18061/dsq.v34i1.1741
The purpose of this article was to examine changes in participants’ perceptions when using Facilitated Communication Training (FCT) and explore strategies to reduce physical support.
The authors describe FCT as an “access strategy” whereby a facilitator “supports, but does not direct, someone so they can communicate functionally using a communication aid. However, they also eschew controlled testing that, to date, has resulted in overwhelming evidence that facilitators and not those being facilitated are authoring the messages. Facilitators often do not consciously realize the extent to which they are influencing and controlling the typed messages due, in part, to the ideomotor phenomenon, or non-conscious muscle movements.
The authors favor data collection techniques that stop short of determining true authorship: analysis of written output, interviews with family members and educators, and a taking the typed messages at face value (e.g., presuming competence). None of these data collection methods adequately address the issue of independent authorship.
The authors favored fading support, defining it as “a graded, systematic individualized process with the intent of achieving independence from physical support.” However, there is no evidence that fading support from the wrist to the shoulder decreases the amount of physical and verbal cuing from the facilitator. There is no reliable documentation demonstrating the “successful” FCT users have achieved independence, that is the ability to type sophisticated messages without interference from a facilitator.
The report reported on attitudinal changes of the family members and facilitators with the introduction of FCT ranging from initial skepticism to hopefulness to acceptance. The presumption that individuals can learn is not dependent on the use of FCT. Changes in the perceptions of the FCT users themselves relied solely on facilitated messages. Since no controls were put in place to determine authorship, any messages obtained are, most likely (higher than chance) the facilitators’ and not those of the individuals being facilitated.
2012
Grayson, A., Emerson, A., Howard-Jones, P., and O’Neil, L. (2012). Hidden communicative competence: Case study evidence using eye-tracking and video analysis. Autism. 16 (1); 75-86. DOI: 10.1177/1362361310393260
The principle aim of this observational case study is to describe precisely and reliably the relationship between an FC user’s looking and pointing behavior by using specialist eye-tracking equipment and fine-grained video analysis.
Critiques:
Authorship is not the same thing as “looking and pointing” behaviors, which can be influenced by facilitator’s movements. Cuing, which becomes subtler with practice (e.g., five years), does not have to involved touch to have a major impact on written output. The facilitator’s physical movements (e.g., shifts in weight, head movements, expressions), as well as verbal output can and do influence which letters are selected (see the ideomotor response for more information).
There is a difference between expression and literacy skills. FC inhibits an individual’s ability for independence expression by building an unhealthy reliance on the facilitator. A person can have the ability to express desired information without being literate. Reading and written language are skills that need to be taught and are not innately known to individuals.
Qualitative data are not “empirical.” Observations, interviews, and analysis of written output when two people are integrally connected during the typing process are inadequate measures of authorship. Systematic observation, no matter how carefully done, cannot address the issue of facilitator influence over the typed messages.
The study claims quantitative or controlled studies of FC test the user (e.g., the person being subjected to facilitation), but the purpose of the tests is not to determine intelligence or to trick the person with disabilities. Controlled studies blind the facilitator to test protocols to determine facilitator influence over the FC-generated messages. Under these conditions, researchers have consistently demonstrated facilitator influence and control. The individual in the study, reportedly, shows no functional literacy skills other than through FC, raising distinct concerns over facilitator control and authorship.
The eye tracking equipment used in the study is effective for allowing individuals to interact with a keyboard independently and without interference from a facilitator. The introduction of FC confounds the results due to facilitator cuing (e.g., movements toward a desired letter or the next letter in a word sequence) which can occur inadvertently but diminishes the likelihood that the individual was selecting letters without help from the facilitator.
The authors report that the individual was “consistently and continuously looking at what he was doing,” but qualify this statement with descriptions of difficulties in calibrating the equipment, head movements and “the exacting nature of the lookzone criterion.” They can’t have it both ways. Eye tracking equipment, used on its own, can be adjusted for head movements of the individual (e.g., for a person who exhibits tremors), as well as the duration in which an individual visually “locks on” to a letter for selection.
2008
Mirenda, P. (2008). A back door approach to autism and AAC. Augmentative and Alternative Communication, 24, 220-234.
This article includes a discussion of Sue Rubin and , as well as a mention of Tito Mukhopadhyay, both of whom are characterized as independent typers. Mirenda writes: “Rubin is one of a number of individuals whose stories make it clear that at least some individuals with ASD who are also labeled as having significant ID can develop high-level language skills and can learn to read, spell, and write.” In fact, none of these individuals can type without a designated helper sitting within visual, auditory, and/or tactile cueing range.
Critique:
The critique comes from Mirenda herself writes in a later publication, Mirenda, P. (2014). Comments and a personal reflection on the persistence of facilitated communication. Evidence-Based Communication Assessment and Intervention, 8(2), 102–110. https://doi.org/10.1080/17489539.2014.997427
As Mirenda (2014) writes, in reference to her prior impressions of independent typing:
I came to recognize (painfully, to be honest) that my advocacy stance biased me to interpret what I saw on videotapes as independent typing even though other explanations were more plausible (e.g., subtle prompting, resulting in an ideomotor effect), and that, even if independent typing did occur subsequent to FC exposure, only correlational—but definitely not causal—evidence exists with regard to its relationship to FC. In short, I do not endorse FC as a communication or instructional technique, and I do not support its use.
2004
Gernsbacher, M.A. (2004). Language is More than Speech: A Case Study. Journal of Developmental and Learning Disorders. 8, 79-96.
The purpose of this case study was to document a child’s development from birth to age 8. The child experienced severe challenges with speech development. The author reports on the necessity of distinguishing between language - the mental representation of concepts and their relations - and speech - one means for communicating mental representations.
Critiques:
This article appears on proponent lists of RPM-related literature and, though the term is not used in the study, the author notes the use of physical supports at the wrist, as well as the use of a cardboard “keyboard,” presumably held by the facilitator. The author had contact with the founder of RPM, Soma Mukhopadhyay, as well, indicating she was aware of RPM. Medical records, historical home videos, audio recordings, photographs, and a journal maintained by the mother were used as documentation of progress. There is no indication in the study itself that controls were put in place to determine authorship when facilitated techniques were used. To date, there is no evidence that RPM produces independent communications and several organizations have opposition statements discouraging its members from using the method.
2003
Mirenda, P. (2003). “He’s not really a reader…”: Perspectives on supporting literacy development in individuals with autism. Topics in Language Disorders, 23, 270–281.
In this article, Mirenda characterizes several FC users—Lucy Blackman, Sharisa Kochmeister, Tito Mukhopadhyay and Jamie Burke—as independent typers. In fact, none of these individuals can type without a designated helper sitting within visual, auditory, and/or tactile cueing range.
Critique:
The critique comes from Mirenda herself writes in a later publication, Mirenda, P. (2014). Comments and a personal reflection on the persistence of facilitated communication. Evidence-Based Communication Assessment and Intervention, 8(2), 102–110. https://doi.org/10.1080/17489539.2014.997427
As Mirenda (2014) writes, in reference to her prior impressions of independent typing:
I came to recognize (painfully, to be honest) that my advocacy stance biased me to interpret what I saw on videotapes as independent typing even though other explanations were more plausible (e.g., subtle prompting, resulting in an ideomotor effect), and that, even if independent typing did occur subsequent to FC exposure, only correlational—but definitely not causal—evidence exists with regard to its relationship to FC. In short, I do not endorse FC as a communication or instructional technique, and I do not support its use.
2002
Niemi and Karna-Lin. (2002, October). Grammar and Lexicon in Facilitated Communication: A Linguistic Authorship Analysis of a Finnish Case. Mental Retardation. Vol 40 (5); 347-357. DOI: 10.1352/0047-6765(2002)040<0347:GALIFC>2.0.CO;2
The purpose of this article was to report on a case study examining the authorship issue in facilitated communication. 1 individual with cerebral palsy was included in the discussion. The number of facilitators was not included. The authors conducted a linguistic authorship analysis and argued that the idiosyncrasy and agrammaticality of word-forms and sentences demonstrated that the written output was that of the individual with disabilities and not those of his facilitators.
Critiques:
Analyzing the written output of two people involved in the act of typing without appropriate controls in place does not reveal the contribution of each individual.
Analysis of a TV appearance by the facilitator and the individual with disabilities revealed visual evidence calling into question independent authorship. Saloviita and Sariola noted the following that raised questions of authorship: 1) the facilitator supported the individual’s hand at the wrist, sometimes using two hands; 2) the facilitator consistently looked at the keyboard, while the individual being facilitated did not; 3) the individual with disabilities made verbal utterances while typing something completely different.
No reliable documentation was provided of the individual’s reading ability, a prerequisite for typed communication.
Written output exceeded expected age-appropriateness for the individual with disabilities.
No controls were put in place to rule out facilitator influence.
The use of facilitated communication may be exploitative and build false hopes.
This study and/or the case discussed is reviewed in the following:
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
Nakajima, S. (2003, May-June). The ‘Miracle Poet’ case: Japanese media fooled by the Doman method and Facilitated Communication (Special Report). Skeptical Inquirer. 27 (3), 12-13.
Saloviita, T. and Sariola, H. (2003, November). Authorship in Facilitated Communication: A Re-Analysis of a Case of Assumed Representative Authentic Writing. Mental Retardation. 41 (5); 374-379; Discussion 380-385. DOI: 10.1352/0047-6765(2003)41<374:AIFCAR>2.0.CO;2
Sturmey, P. (2003, October). Typing in Tongues: Interesting Observations on Facilitated Communication Do Not Establish Authorship. Mental Retardation. 41 (5), 386-387. DOI: 10.1352/0047-6765(2003)41<386:TITIOO>2.0.CO;2
2001
Emerson, Grayson, and Griffiths. (2001). Can't or Won't? Evidence relating to authorship in Facilitated Communication. International Journal of Language and Communication Disorders. 36 Supplemental: 98-103. DOI: 10.3109/13682820109177866
The purpose of this study was to evaluate FC through sources other than controlled testing. 14 individuals with autism and/or other developmental disabilities participated. The number of facilitators was unspecified. Data was collected using videotaped sessions and diary records. Individuals with disabilities were shown pictures or objects unseen by the facilitators. Results indicated that, given to total number of trials, performances above the level of chance were infrequent. The authors reported that the analysis of transcripts from routinely occurring FC sessions provided evidence of FC authorship.
Critiques:
Used data collection methods that did not control for or rule out facilitator influence.
Participants were allowed to practice tests (with and without facilitation), which may have lead to increased success or “above-chance” results.
Researchers under reported or omitted altogether how they calculated “above-chance” responses, making the claim anecdotal rather than evidence-based.
Circular reasoning is used when claims of authorship and accurate information obtained via FC were the result of the individuals themselves using FC.
Authors gave more weight to responses in uncontrolled circumstances (which resulted in correct information) than controlled circumstances (which failed to produce correct responses in most of the participants).
This study is reviewed in the following:
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
1997
Biklen, D. & Cardinal, D. (1997). Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy. New York, NY: Teacher’s College Press.
As noted by Kezucka (1999, Autism, vol. 3, 205-207) “the ‘ideal validation studies’ used to defend FC in this book are marred by serious drawbacks in procedures and statistical analysis (i.e., the method of scoring, the rating scale, and so on.) and ‘vividly illustrating facilitator influence.’”
1996
Bebko, J. M., Perry, A., & Bryson, S. (1996). Multiple method validation study of facilitated communication: II. Individual differences and subgroups results. Journal of Autism and Developmental Disorders, 26, 19-42. DOI: 10.1007/BF02276233
The purpose of this was the evaluation of FC. 16 facilitators and 20 individuals with autism and/or developmental delays participated. Test protocols included training for the study, multiple facilitation methods, auditory and visual input, and the use of informed and naive facilitators. Results indicated that there was significant facilitator influence, but less than other studies. Subjects may appear more positive when using FC, but communicated more effectively without FC. Subjects’ independent responses lessened after introduction of FC.
Critiques:
Authors claim there was significant facilitator influence, but “less than other studies.” The article contains insufficient information to show how this determination was made.
Study lacks objective data to determine how a “more positive” outlook was measured in individuals subjected to FC.
See Bebko, Perry, and Bryson (2003, April). Commentary: Bebko, Perry, and Bryson on Mostert (2001), “Facilitated Communication Since 1995” Journal of Autism and Developmental Disorders, Vol 33 (2), 219-220 for further discussion about the authors’ position regarding the use of FC. In the commentary, they emphasize clear risk factors in the use of FC and the need for “extreme caution an for ongoing case by case objective evaluations if FC is going to be introduced for any individual.” (p. 220).
Cardinal, DN, Hanson, D, Wakeham, J. (1996). Investigation of authorship in facilitated communication. Mental Retardation. Vol 34 (4), pp 231-242.
The purpose of this study was to explore the transmission of rudimentary information to a naive facilitator. 31 facilitators and 32 individuals with autism and/or developmental delays participated. Facilitators received training by personnel from the Facilitated Communication Institute at Syracuse University. Test protocols included the use of flash cards presented orally to the individual with disabilities without the facilitator present. Results indicated that under controlled conditions, some FC users can pass information to a facilitator when that facilitator is not aware of the information. The measurement of FC under test conditions may be significantly benefited by extensive practice of the test protocol.
Critiques:
The study does not control adequately for data collector bias and/or facilitator influence.
Facilitators were included in developing test protocols, increasing the chances of accurate guesses by facilitators and/or recorders.
The individuals involved in the study were allowed to practice first, which may have influenced the success rate in subsequent sessions.
This study is reviewed in the following:
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
Sheehan, C. M., & Matuozzi, R. T. (1996). Investigation of the validity of facilitated communication through disclosure of unknown information. Mental Retardation, 34, 94-107.
The purpose of this study was to validate FC in corroborating unknown information. 2 facilitators and 3 individuals with autism and/or developmental delays participated. Test protocols included the use of a naive facilitator. The results indicated that sometimes the subjects were able to communicate information using a naive facilitator, but facilitator influence was not ruled out.
Unexpected literacy skills in users after the onset of facilitated communication.
In the case of inconsistent responses, facilitators were allowed to question participants’ further to elicit further (correct) responses.
A “naive” facilitator was used to answer questions about particular videos or other test material, but researchers don’t say whether the facilitator was involved with developing test protocols. If so, this increases the chances the facilitator could guess correct answers based on the limited number of activities available during test conditions.
Researchers used unprovable FC-generated messages to determine authorship (e.g., the participants’ likes and dislikes, as well as impressions, of the materials viewed during test protocols), claiming these typed responses were unknown to the facilitator.
Researchers advance the unsubstantiated claim that individuals’ ability to message-pass decreases under controlled or “stressful” situations.
Researchers advance the idea that communication is a shared experience, while rationalizing away or minimizing concerns of facilitator influence and control over the FC-generated messages.
Weiss, M. J., Wagner, S. H., & Bauman, M. L. (1996). A validated case study of facilitated communication. Mental Retardation, 34, 220-230.
The purpose of this study was to determine the effectiveness of FC. 1 facilitator and 1 individual with autism and developmental delays participated. The facilitator attended a number of FC seminars and developed the technique while working with the student. Test protocols included the use of an uninformed facilitator. Results indicated that the subject accurately answered questions, but the activities were terminated with the subject began giving incorrect answers.
Critiques:
Researchers attempted to use controlled (blinded) test protocols, but then used an intermediary “consolidation” phase which exposed the “naive” facilitator to test questions and information that was then used in the test phase. The purpose of the consolidation phase was not made clear in the report, but appears to have increased the chances for facilitator influence without representing any to of evidence of validation.
Referees, whose role was to verify that the facilitator was uninformed of the story content, were only available for the third trial, leaving open the possibility that the “naive” facilitator had access to test information.
The second trial was stopped because of facilitated messages that researchers attributed to the facilitator, not the individual with disabilities. This same facilitator was used throughout the testing, which calls into question the independence of any of the FC-messages, regardless of claims of accuracy and validity.
Researchers purposefully left out “distractor conditions” in which the facilitator was presented different information than the individual with disabilities. This is a key element of determining authorship and calls into question claims of authorship, which cannot be reliably determined without controls.
This article is reviewed in the following:
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
1995
Biklen, D., Saha, N, & Kliewer, C. (1995). How Teachers Confirm the Authorship of Facilitated Communication: A Portfolio Approach. Research and Practice for Persons with Severe Disabilities. Vol 20 (1), 45-56. DOI: 10.1177/154079699502000105
The purpose of this article was to demonstrate how facilitators assess messages obtained using FC. 7 facilitators and 17 individuals with autism and/or developmental delays were included in the observations. Validity of FC was determined by “demonstrable differences” in students’ attention, typing, messaging, and content compiled in a cumulative “student and communication portfolio.”
Critiques:
Anecdotal, does not include controls to rule out facilitator influence.
Used “qualitative” measures (observations of teachers with their students, teacher interviews, and analysis of facilitated, written transcripts) that cannot account for the separate contribution of the facilitator v. those of the individuals with disabilities.
Speed of typing, varying word usage, and content are not indicators of independent communication. Facilitator cuing can, inadvertently, influence any of these.
Spoken output by individuals in the study were minimized or ignored in lieu of the facilitated messages.
Message passing, or conveying accurate information not known to the facilitator, must be done under controlled circumstances. Facilitators share information (covertly or overtly), which may influence the written output.
A portfolio approach amasses facilitated messages, but does not address the issue of facilitator influence and authorship.
Janzen-Wilde, M.L., Duchan, J.F., and Higginbotham, D.J. (1995, June). Successful Use of Facilitated Communication with an Oral Child. Journal of Speech and Hearing Research. Volume 38 (3), 658-676. DOI: 10.1044/jshr.3803.658
The purpose of this study was to compare the oral and spelled utterances of a 6.5 year-old child over a 3-month period while he was trained in FC.
Researchers analyzed the child’s written output for idiosyncratic use of language, which they took for “independent” communication. With the introduction of the facilitator, the child’s written output became significantly better than his oral language in terms of length of utterances, novelty of utterances, and syntactic complexity. No controls were put in place to determine the degree of facilitator control and influence over the written output and/or to rule out facilitator influence because of the ideomotor effect. Authorship in controlled studies is attributed to the facilitators and not those who are being facilitated.
The child exhibited basic language and literacy skills, plus the motor control to type messages without physical support, begging the question of why a facilitator was necessary in the first place.
1994
Clarkson, G. (1994). Creative music therapy and facilitated communication: New ways of reaching students with autism. Preventing School Failure, 28, 31-33. DOI: 10.1080/1045988X.1994.9944301
The purpose of this article was to report success using FC during music therapy sessions. 2 facilitators and 1 individual with autism were mentioned. Facilitators reported that the subject communicated more with FC.
Critiques:
Anecdotal. No controls were put into place to rule out alternative explanations (e.g., facilitator control).
Objective measures were not put into place to determine pre- and post- language abilities and behavior of the individual with disabilities. Outcomes were based on perception, not evidential data.
Heckler. S (1994). Facilitated communication: A response by child protection. Child Abuse and Neglect, 18, 495-503. DOI: 10.1016/0145-2134(94)90003-51
The purpose of this study was to determine facilitator influence in supported typing (FC). 2 facilitators and 1 individual with autism participated. The Child Protection Agency (CPA) received a report that a 7-year-old child with autism had been sexually abused. The report was based solely on messages obtained using facilitated communication. Test protocols included the use of an informed and naive facilitator. The results indicated that subjects consistently chose incorrect responses for controls 1 and 3 of the study, but mixed responses for control 2. Follow-up showed some accuracy of events unknown to the facilitator. There was no physical substantiation of sexual abuse.
Critique:
Though the client participated willingly in the FC session and consistently chose the wrong answers during a “guessing game” activity, evaluators called into question the outcome, citing proponent literature indicating that testing individuals using FC is disrespectful will cause them to choose not to participate. (Biklen, Morton, Gold, Berrigan, and Swaminathan, 1992).
During facilitation, the client sat on the facilitator’s lap, increasing the likelihood of overt and covert facilitator cuing.
Evaluators accepted three “correct” responses without question, but speculated on the client’s comprehension skills and short-term memory when the answers were wrong. It couldn’t be ruled out that the facilitator had prior knowledge to the information revealed in the correct responses. Evaluators also seemed to blame the inconsistent responses on the client, revealing that the individual responded affirmatively when asked about teasing the facilitator.
Despite questions about the individual’s language abilities, no thorough language comprehension assessment was conducted.
The use of a neutral facilitator in cases of suspected abuse does not guarantee validity of facilitated messages and does not protect individuals from being falsely accused.
Most organizations with statements opposing the use of facilitated communication warn against using FC as a means of confirming allegations of abuse.
1993
Sabin, LA, and Donnellan, AM (1993). A qualitative study of the process of Facilitated Communication. Journal of the Association for the Severely Handicapped, 18, 200-211. 10.1177/154079699301800306
The purpose of this study was to report the successful use of FC using qualitative measures. 7 facilitators and 2 individuals with autism and/or developmental delays participated. Facilitated messages included words, phrases and sentences. No controls were in place to rule out facilitator influence and control.
Critiques:
Researches dismiss at the outset concerns of facilitator influence and chose not to factor in the possibility of facilitator influence in their study.
Researchers used “qualitative” measures (e.g., observation, interviews with parents and educators) to determine outcomes, without putting controls into place to determine facilitator influence or address the issue of authorship.
Researchers equate longevity of the practice with efficacy of the practice. Producing a large collection of FC-authored messages does not address the question of validity.
Neither of the students in the study exhibited age-appropriate abilities on academic tasks before the onset of FC, but exhibited unexpected literacy skills at the onset of FC. Language and literacy skills need to be taught and are not just products of being exposed to books, television, radio, etc. in the environment.
Facilitators used supportive techniques that call into question independent communication: pushing and pulling the student’s arm to control activity, blocking the students’ non-typing hand from the keyboard, physically restraining the students’ movments (e.g., whole body support), censoring students’ verbal output in lieu of typed output, ignoring students’ non-verbal behavior (pulling away from the facilitator, resisting the activity).
Speculation that autism is a motor planning problem, an unsubstantiated claim that runs throughout pro-FC literature.
Researchers ignore outcomes that document significant facilitator control and influence over the typing sessions in their recommendation to continue studying the process of facilitation as a “partnership” and fail to recommend further study to rule out facilitator control during these sessions.
1992
Biklen, D., Morton, MW, Gold, D, Berrigan, C. and Swaminathan, S. (1992). Facilitated Communication: Implications for individuals with autism. Topics in Language Disorders, 12, 1-28. DOI: 10.1097/00011363-199208000-00003
The purpose of this article was to report verification of students’ abilities using FC. 43 individuals with autism were observed working in an unspecified number of facilitators. Success was reported for 41 out of 43 individuals. Facilitated messages contained words, phrases, sentences and questions that were used to determine validity. Students, purportedly, moved from structured to unstructured work.
Critiques:
Anecdotal, lacks controls to rule out facilitator influence.
Uses “qualitative” measures (e.g., observation, analysis of written output) as “proof” of authorship.
The structured work sessions contained information that was known to facilitators, so facilitator influence cannot be ruled out.
Written messages were prioritized over spoken language output.
Validation measures used by facilitators included: speed and accuracy of typing, typographical errors, invented spellings, unusual or unexpected phrases or sentences, revelation of personality traits. These validation measures cannot determine authorship when two people are involved with the typing activity without appropriate controls in place.
Unsubstantiated claims that apraxia, or motor planning problems, are a primary characteristic of autism.
Biklen, D., Morton, M.W., Gold, D., Berrigan, C., Swaminathan, S. (1992, August). Facilitated Communication: implications for individuals with autism. Topics in Language Disorders. 12 (4), 1-28. DOI: 10.1097/00011363-199208000-00003
This article explores the processes and strategies teachers and others used to type using facilitated communication, including the use of open-ended conversations. physical support, and attitudinal support to create opportunities for communication. 43 individuals with autism participated in the study.
Individuals with echolalic speech were reported to make significant improvements with typed messages when facilitated. Echolalia generally viewed as a pre-cursor to fluent spoken language. It would not be expected that individuals at this stage would have the requisite skills for literacy (e.g., reading and written language skills). See Echoes of Language and Echolalia and its Role in Gestalt Language Acquisition for more information.
Proponents hypothesize that FC training helps individuals with autism overcome neuromotor difficulties. Evidence-based methods and technologies exist that allow individuals with physical and communication difficulties interact with communication devices independently and without interference from a facilitator.
This study uses “qualitative” methods (e.g., observations, interviews with parents and teachers, videotapes, analysis of typed messages) to determine the efficacy of FC. Authorship cannot be determined by these measures. Controlled studies indicate that facilitators, not the individuals being facilitated, influence and control messages using FC.
Calculator, S.N. and Singer, K.M. (1992, November). Letter to the editor: Preliminary validation of facilitated communication. Topics in Language Disorders, 13 (1), ix-xvi.
The purpose of this study was to validate the impact of facilitated communication on uncovering students’ underlying communication skills and provide accurate diagnostic information on the students as a basis for designing appropriate educational programs. Five school-age boys participated in the investigation. Each required facilitation at the wrist. Parents of all five children were, reportedly, eager to participate. The PPVT-R was used as a measure, which requires students to point to pictures in a multiple choice fashion. Results indicated no change in two of the students and marked improvement in three of the students.
This article is often included on proponent lists as “proof” of authorship. The PPVT-R requires only one-word responses, however, and the authors report that the results of the testing was not enough to satisfy concerns about facilitator influence in more involved written language activities (e.g., misspellings, novel information, idiosyncratic spellings and uses of words).
The authors wrote: In light of the present findings and those of Cummins and Prior discussed earlier, however, it appears nothing short of irresponsible to claim newly discovered abilities before such skills are empirically validated. In other words, the authors supported the use of controlled studies to further investigate the phenomenon.
As to the issue of not testing (as outlined in pro-FC guidelines), the authors suggest that any harm to subjects “may be more of an artifact of the way in which testing is conducted than its mere use.” Respectful treatment by examiners of individuals with disabilities and their facilitators increases the chances of positive outcomes under controlled testing situations.
Crossley, R. (1992). Getting the words out: Case studies in facilitated communication training. Topics in Language Disorders, 12, 46-59. DOI: 10.1097/00011363-199208000-00005
The purpose of this study was to report case studies with individuals using FC. 3 individuals with developmental or other disabilities were mentioned. The number of facilitators was unspecified. Observations of successful facilitated messages by all three individuals included phrases, sentences and questions.
Critiques:
Anecdotal, no controls were in place to rule out facilitator influence and control.
Unexpected spelling ability and other written language abilities.
Unsubstantiated claims that individuals learned language and literacy skills from “ambient” print (e.g., books, newspapers, magazines, TV commercials).
Structured activities involved information facilitators knew and their influence in obtaining correct answers could not be ruled out.
“Independence” was defined as including facilitator support.
Fading support from the wrist to the elbow, shoulder, other body part, or clothing does not limit facilitator cuing. Concerns that client dependence on the facilitator for success were not addressed adequately.
Validation of messages relied on facilitator judgment, not objective measures.
1991
Biklen, D., Morton, MW, Saha, SN, Duncan,J, Gold, D, Hardordottir, M, Karna, E., O'Connor, S., and Rao, S. (1991). "I AMN OT A UTISTIVC ON THJE TYP". Disability, Handicap, & Society, 6, 161-179. DOI: 10.1080/02674649166780231
The purpose of this article was to report success of individuals using facilitated communication. Facilitated messages contained words, phrases, sentences, and questions. 22 individuals with autism were mentioned, with an unspecified number of facilitators.
Critiques:
Anecdotal, lacks controls in place to rule out facilitator influence and control.
Reports of unexpected literacy skills via facilitation, often in the first session.
Reports of students verbally producing utterances while simultaneously typing content that differed from the verbal output.
Claims of “independent” output while being physically held by a facilitator.
Validation methods (e.g., sentence structure, analysis of written output, observation) that, without appropriate controls in place, cannot separate the contribution of the facilitator with those of the individuals with disabilities.
Spoken output by individuals in the study were minimized or ignored in lieu of the facilitated messages.
Individuals being facilitated were often not looking at the letter board during the typing activity.
Unsubstantiated claims that autism is primarily a motor planning problem.
Biklen, D. and Schubert, A. (1991, November-December). New Words: The Communication of Students with Autism. Remedial and Special Education. Volume 12 (6), pp. 46-57. DOI: 10.1177/074193259101200607
The purpose of this study was to document the effects of FC on individuals with autism in “unlocking their ideas” as they type with the assistance of facilitators. 21 students participated. The authors reported unexpected literacy and numeracy skills in the individuals and claimed this “challenges traditional assumptions about autism” in the analysis and use of language.
Critiques:
The revelation of unexpected literacy skills raises concerns of facilitator influence. The report indicates that many of the parents were surprised at the high level of literacy but attributed it to being exposed to books in their environment, watching television shows or witnessing siblings doing schoolwork. Language and literacy skills, particularly reading and written language, cannot be learned “incidentally,” and need to be taught.
Facilitator support at the hand and wrist raise issues of unintended or non-conscious cuing due to the ideomotor effect. The report also indicates that the facilitators pulled the individuals’ hands back 8 or 10 inches from the keyboard or letter display, indicating direct and conscious influence over the typed messages. Facilitator doubts about influence were rationalized away by focusing on the written output and the different personalities represented in the writing. Authors come up with characters for their books all the time that have different “voices.” This is a poor substitution for controlled testing.
The initial training and introduction to FC includes information the facilitators know, with direct instruction not to test for competence. Without testing in which the facilitator is blinded to test protocols, there is no reliable way to determine whether or not the individual is typing independently. Results from controlled studies provide strong evidence that the messages are facilitator generated and not those of individuals with disabilities.
The guidelines suggest fading physical support with no set parameters for when this fading should begin. According to the report, it could take a number of months or even years. This suggests that facilitator support is integral to how FC “works” and raises concerns of prompt dependency.
Individuals with echolalic speech, a pre-cursor to spontaneous language output, are unlikely to have the prerequisite skills to type sophisticated written messages independently. Some individuals have hyperlexia, a precocious ability to decode written words but without understanding their meanings, but, as Katherine Beals notes in her review of the book, Beyond Reasonable, “…it’s not the case that print-attentive, hyperlexic children (with or without autism) understand spoken language only after they’ve learned to read and spell.
Fluency in FC-generated messages does not assure that the messages were typed independently and without the interference of the facilitator. Analyzing written output alone does not rule out facilitator control or determine authorship.
1990
Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review, 60, 291-315. DOI: 10.1080/21548331.1992.11705407
The purpose of this article was to advance the idea of FC and autism as a motor planning problem. 21 individuals with autism participated. The number of facilitators was unspecified. No controls were used to determine facilitator influence. The observed FC production was at the word, phrase, and sentence levels. Results indicated that the proportion of FC users showing unexpected literacy skills was 100%, including 8 in the first FC session.
Critiques:
Makes an assumption that FC “works” without exploring alternative explanations (e.g., facilitator influence)
Insufficient data in terms of students’ written and spoken language abilities prior to introduction to FC.
No controls were used to rule out facilitator authorship.
Unsubstantiated claims that autism is primarily a motor planning problem.
Anecdotal, rather than evidence-based.