Materials for Educators

DESCRIPTION

FC is a technique alleged to help people overcome severe communication difficulties simply through the use of physical support. It involves a facilitator physically touching the hand, elbow, shoulder, back or other body part to prompt a person with limited functional spoken or written language abilities to spell out words and sentences on a keyboard or similar device. RPM differs slightly in that the facilitator holds the keyboard in the air while the person with disabilities points to letters.

Alternative names for FC and RPM: supported typing, typing to communicate, informative pointing, spelling to communicate, hand-over-hand, motor communication, speaking with eyes.

FACILITATOR AUTHORSHIP OF FC AND RPM MESSAGES

Scientific research—confirmed by dozens of experimental studies and nine systematic reviews (1993 to 2019)—has demonstrated repeatedly that the words obtained by using FC are totally authored by the facilitator and not the person with disabilities.

There are currently no scientifically sound empirical studies of RPM (due to proponent resistance to controlled testing). Nonetheless, RPM’s similarities to FC have prompted the American Speech-Language-Hearing Association (ASHA), American Association on Intellectual and Development Disabilities (AAIDD), and other organizations to adopt positions opposing its use, citing concerns over facilitator influence, human rights violations, and potential and real harms caused by false allegations of abuse.

IDEOMOTOR EFFECT

FC is a facilitator-dependent technique reliant on physical and verbal cues provided by the facilitator to initiate movement and make corrections throughout the typing activity. These cues, over time, can become very subtle. Often facilitators are unaware of their influence over the typing process due to a well-documented phenomenon called the ideomotor effect. The ideomotor effect allows a person to produce small muscle movements without necessarily being conscious of the actions (also seen in dowsing, automatic writing, and using a planchette or ouija board). Proponents claim to be able to “fade” their support (gradually eliminate it over time). However, the success of FC depends on the facilitator’s physical proximity to the person with disabilities. Shifts in body weight, finger movement, tone of voice, and the like by the facilitator all influence where the other person’s hand is on the keyboard and what letters are typed. Moving support from the wrist to the shoulder, for example, does not eliminate cuing provided by the facilitators. The subtlety of this cuing can erroneously trick well-intentioned facilitators and observers into believing the person is typing independently.

 DETERMINING FC AUTHORSHIP

The only reliable method for validating FC authorship is carefully controlled, double-blind testing.

Most proponents reject empirical studies, citing instead research studies employing unreliable protocols:

1) Studies in which facilitators were provided with prior information in the test protocols (by error or by design), or

2) Studies that provide insufficient information documenting subjects’ independent communication abilities prior to the test, confounding the results when subjects may have typed words (e.g., their own name, colors) that they already knew, or

3) Studies which claim to test authorship by analyzing the language structures obtained during FC sessions. Unique spellings, unusual language structures, senses of humor, etc. are inadequate in reliably determining the degree to which messages are typed independently (without facilitator influence or control). These studies use circular reasoning: FC works because people using FC say it works.

Research studies have shown that when facilitators are restricted from having access to test protocols (blinded), the resulting typed messages are either unintelligible or based solely on information facilitators received during the testing activities.

FC is not AAC

Typing is a legitimate form of augmentative and alternative communication (AAC)—if the person doing the typing can do so without the influence of another person. Recognized AAC techniques and methods are evidence-based and assist the person with disabilities in their ability to communicate independently. FC and its variants are not recognized as valid AAC techniques because of their dependence on a facilitator.

In their 2014 position statement on Facilitated Communication, the International Society for Augmentative and Alternative Communication (ISAAC) stated:

The use of FC appears to be in violation of several articles of the United Nations Conventions on the Rights of Persons with Disabilities (i.e., Articles 12, 16, 17, and 21) as it has been shown to prevent individuals without sufficient spoken language from using their own ‘voice.’

People who could be receiving support using communication methods that are demonstrably effective (e.g., manual sign language, graphic symbols, gestures) are being deprived of this support. FC obstructs the individual's authentic communication and violates the fundamental right to self-expression.

POTENTIAL FOR HARM

Facilitators and FC proponents claim the technique promotes acceptance, inclusion, and diversity. These are values they share with critics of the technique. However, facilitators ultimately undermine inclusion and acceptance by unconsciously substituting their own messages and voice for those of the very people they claim FC emancipates. Indeed, facilitators often give credence only to facilitated messages and are taught to minimize or ignore the disabled person’s other communicative behaviors (i.e., their vocal protests, walking away, pulling or pushing, etc.).

Facilitated communication has caused serious harm to people with communication disabilities, their families, caregivers, and professionals. Along with significant and costly loss of time, resources, and the opportunity to access effective communication interventions, FC has been the source of numerous false allegations of sexual abuse against people in Australia (where FC originated), the United States, Canada, and certain parts of Europe. Additionally, facilitators have committed crimes, including sexual assault against non-speaking people with disabilities, claiming that they were given consent via FC-generated messages. Tragically, one parent force-fed her 8-year-old autistic son a fatal doses of pills after facilitating messages that he wanted to die. She was subsequently convicted of manslaughter.

GUIDELINES & FALSE ALLEGATIONS

Proponent guidelines for FC encourage its use for forensic interviews regarding suspected abuse. These guidelines omit the need for reliable, evidence-based methods for assessing authorship (e.g., controlled, double-blind testing).

Additionally, the guidelines advise the use of a second or “naive” facilitator to corroborate claims made using FC. However, merely obtaining additional information using FC fails to determine authorship or safeguard against false accusations.

This is particularly alarming since some organizations allow FC to be used during counseling sessions, leaving parents, facilitators, human services workers, law enforcement, and other public institutions vulnerable to criminal and civil action when FC is used to generate false accusations.

LACK OF OVERSIGHT

FC proponents and facilitators trained at Syracuse University's Institute for Communication and Inclusion and other organizations have continued to disseminate this widely discredited and dangerous practice. Other than taking classes and participating in FC training workshops, “master facilitators” have no licensing requirements or regulatory oversight to become master facilitators. Nor does the practice of FC have any professional standards by which facilitators could be regulated.

Note: The Communication Sciences and Disorders department at Syracuse University, which uses empirically-based methods, does not support the use of FC or its variants.

RECOMMENDED VIEWING:

The Return of Facilitated Communication: Current Events and Implications for Misrepresenting Autism

RECOMMENDED READING

Note: Many of these articles are behind paywalls. However, most libraries have databases or interlibrary loan that give access to patrons for free. Please contact us if you have difficulty accessing the resources.

Burgess, C.A., Kirsch, I., Shane, H., Niederauer, K.L., Graham, S.M., Bacon, A. (January 1998). Facilitated Communication as an Ideomotor Response. Psychological Science, 9(1), 71-74. https://www.jstor.org/stable/40063250

“Forty college students were taught facilitated communication via a commercially available training videotape. They were then asked to facilitate the communication of a confederate, who was described as developmentally disabled and unable to speak. All 40 participants produced responses that they attributed at least partially to the confederate, and most attributed all of the communication entirely to her… These data support the hypothesis that facilitated communication is an instance of automatic writing, akin to that observed in hypnosis and with Ouija boards, and that the ability to produce automatic writing is more common than previously thought.”

Burke, M. (2016, April). How facilitators control words typed in facilitated communication without realizing it. Daily Orange.

“…a facilitator’s ability to control authorship in FC without noticing is because of an ‘ideomotor effect.’ More commonly referred to as Ouija board effect, it occurs when people have motor activity without being consciously aware of it.”

Condillac, R., and Perry, A. (2003). Evidence-based practices for children and adolescents with autism spectrum disorders: Review of literature and practice guide. Children’s Mental Health. Ontario. Toronto, ON.

This comprehensive review describes a range of interventions and practices utilized in autism and summarizes the evidence base for each. The section on facilitated communication notes: “The research does not provide support for the validity of FC. The more methodologically rigorous the research design, the more clear-cut the lack of validity. Research has consistently shown that it is the facilitators (not the clients) who determine the content of the typed messages (though unconsciously).”

Gorman, B.J. (2011). Psychology and Law in the Classroom: How the Use of Clinical Fads in the Classroom may Awaken the Educational Malpractice Claim. Brigham Young University Education and Law Journal, 2011 (1), 29-50.

This article explores the concept of a reasonable duty of care for educators who use scientifically rejected practices in the classroom (i.e., practices that have been subjected to empirical testing within the relevant assessment community and subsequently rejected). When applied to FC, a scientifically discredited technique, this may leave educators vulnerable to educational malpractice claims.

Hemsley, B., Bryant, L., Schlosser, R.W., Shane, H.C., Lang, R., Paul, D, Banajee, M., Ireland, M. (2018). Systematic review of facilitated communication 2014-2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism and Developmental Language Impairments, 3, 1-8. DOI: 10.1177/2396941518821570

This systematic review was conducted to inform the 2018 updated of the 1995 American Speech-Language-Hearing Association Position Statement on FC. Existing systematic reviews up to 2014 revealed no evidence that FC-generated messages were authored by the individual with disability. Authors conducted a search for evidence-based studies pertaining to authorship and FC. The review team concluded that there were no new studies on authorship and no evidence that FC is a valid form of communication for individuals with severe communication disabilities.

Hemsley, B., Shane, H., Todd, J.T., Schlosser, R., and Lang, R. (2018, May 22). It’s time to stop exposing people to the dangers of facilitated communication. The Conversation.

This article provides a short history of facilitated communication, the harms it can do, and the right of individuals with disabilities to communicate independently.

Jacobson, J.W., Foxx, R.M., and Mulick, J.A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc. ISBN: 978-1138802230

This book addresses the question of what approaches to early intervention, education, therapy, and remediation really help those with developmental disabilities and what approaches represent a waste of time, effort, and resources. It identifies major controversies, reviews questionable practices, and offers ways to appraise the quality of services.

Kezuka E. (October 1997). The Role of Touch in Facilitated Communication. Journal of Autism and Developmental Disorders, 27(5), 571-593. DOI: 10.1023/A:1025882127478

This article documents experiments that were conducted involving a “telepathy game” using a rod with an attached strain gauge. A force from the assistant, which controlled what was spelled through physical support, was measured. It was thus completely possible for any message to appear to be typed with FC regardless of the autistic child's actual knowledge or language ability.

Lilienfeld, S.O. (2005). Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary. Pediatrics, 115 (3), 761-764.

This article offers basic guidelines for distinguishing scientifically supported from unsupported treatments for individuals with autism, ADHD, and conduct disorder.

“FC is premised on the notion that autistic children suffer not from an intellectual and affective impairment but from an exclusively motor impairment termed developmental apraxia, which impedes their ability to speak properly. Hence, with the aid of a facilitator who guides their hand movements, these children can ostensibly type out complete sentences on a computer keyboard or letter pad. Nevertheless, controlled studies demonstrate overwhelmingly that FC is ineffective and that the resultant communications are a product of inadvertent facilitator control over the child’s hand movements. Although this “ideomotor effect” has been well documented by researchers for decades, the proponents of FC never considered it as an alternative explanation for FC’s seemingly remarkable effects. In addition to gratuitously raising the hopes of the parents of autistic children, FC has resulted in numerous uncorroborated allegations of sexual and physical abuse against these parents". p. 762.

Lilienfeld, S.O. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2, 53.

This article is a discussion of hazardous treatments for individuals within the medical and mental health professions. In it, the author outlines methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs) and discusses the implications of PHTs for clinical science and practice.

“FC has been associated with at least five dozen allegations of child sexual abuse against the parents of autistic children, the substantial majority of which have never been corroborated (Jacobson, Mulick, & Schwartz, 1995). In these cases, the facilitated communications were ostensibly generated by facilitators themselves, who may have either suspected familial abuse or harbored implicit causal theories about a link between early abuse and subsequent autism. Nevertheless, it is not known whether FC generates more false abuse allegations than other suggestive techniques (e.g., repeated questioning and prompting of children) for unearthing abuse (Botash et al., 1994). pp. 59-60.

Palfreman, J. (Producer). (1993, October 19). Frontline: Prisoners of silence. Boston, MA: WGBH Public Television.

This documentary is a comprehensive investigation of Facilitated Communication, a technique that was, at the time, heralded as a breakthrough technique of individuals with complex communication needs, particularly those with autism. While thousands of people embraced the technique, scientists rejected it as simply not real. The facilitators, not the individuals with disabilities, control the messages.

Rogers, S. J. (2006). Evidence-based interventions for language development in young children with autism. In T. Charman & W. Stone (Eds.), Social & communication development in autism spectrum disorders: Early identification, diagnosis, & intervention (p. 143–179). The Guilford Press.

The purpose of this book chapter is to review the main types of empirically supported language interventions that have successfully taught preschool-age children with autism, age 5 or under, to use spoken language, and to consider the strengths and relative weaknesses of each approach. Includes a discussion of what works best for minimally-verbal and non-verbal children with autism.

Schlosser, R.W., Hemsley, B., Shane, H. et al. (2019).Rapid prompting method and autism spectrum disorder: Systematic review exposes lack of evidence. Review Journal of Autism and Developmental Disorders, 6, 403–412.

The purpose of this systematic review was to examine the effectiveness of the rapid prompting method (RPM) based on the empirical demonstration of its effects. Claims that RPM is effective for enhancing motor, speech and language communication, and decreasing problem behaviors in individuals with autism spectrum disorder could not be corroborated. No studies met the inclusion criteria. Researchers called for controlled studies of RPM. Authors outlined criteria to ensure the effectiveness of future studies, including determining whether literacy skills could be demonstrated through the provision of evidence-based approaches.

Simpson, R. (2005, August). Evidence-based practices and students with autism spectrum disorders. Focus on Autism & Other Developmental Disorders, 20 (3). DOI: 10.1177/10883576050200030201

This article discusses issues and factors that relate to identifying and using effective practices for students with autism-related disorders.

Singer, G.H.S., Horner, R.H., Dunlap, G., and Wang, M. (2014). Standards of proof: TASH, facilitated communication, and the science-based practices movement. Research and Practices for Persons with Severe Disabilities, 39 (3), 178-188. DOI: 10.1177/1540796914558831

This article discusses reasonable standards of proof in evaluating the evidence for a practice. With regard to FC, the authors conclude: ''In summary, we find no convincing evidence in the published, peer-reviewed literature to uphold FC as efficacious. The studies that purport to prove the validity of FC have, with a few exceptions, used inappropriate methods for proving cause and effect or poorly controlled experiments.”

Smith, Tristram & Iadarola, Suzannah (2015). Evidence base update for autism spectrum disorder, Journal of Clinical Child & Adolescent Psychology, 44 (6), 897-922. DOI: 10.1080/15374416.2015.1077448

This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in 2008. It identifies two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA+ DSP) and 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training).

Tostanoski, A., et.al. (2014, August). Voices from the past: Comparing the rapid prompting method and facilitated communication. Developmental Neurorehabilitation, 17 (4), 219-223. DOI: 10.3109/17518423.2012.749952

This article briefly reviews the history and damage caused by facilitated communication (FC) and highlights the parallels between FC and the Rapid Prompting Method (RPM).

Travers, J., et al. (2015, January 7). Facilitated communication denies people with disabilities their voice. Research and Practice for Persons with Severe Disabilities, 39 (3), 195-202. DOI: 10.1177/1540796914556778

“FC has experienced resurgence in popularity among families, professionals, and advocacy groups. Strategic marketing, confirmation bias, pseudoscience, anti-science, and fallacy explain this troubling renewal. We briefly discuss each of these and contrast the method with authentic augmentative and alternative communication to illustrate differences in values and practices. Our intention is to persuade readers to resist or abandon FC in favor of validated methods and to encourage advocacy organizations to advance agendas that emphasize genuine self-expression by people with disabilities.”

Wegner, D.M., Fuller, V.A., and Sparrow, B. (2003, July). Clever hands: uncontrolled intelligence in facilitated communication, Journal of Personality & Social Psychology, 85 (1), 5-19. DOI: 10.1037/0022-3514.85.1.5

This study explored how individuals perceive their contribution in answering questions while attributing authorship of their answers to their communication partner.

Whalon K. J., Al Otaiba S., Delano M. E. (2009). Evidence-based reading instruction for individuals with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 24(1):3-16. DOI: 10.1177/1088357608328515

This review synthesizes the literature on reading instruction for children with ASD that encompasses one or more of the five components of reading. The review includes 11 studies with 61 participants ages 4 to 17 years. Results indicate that children with ASD can benefit from reading instruction consistent with reading research. This includes systematically instructing all primary sound-letter relationships in a logical and sequential manner.

Webinars

National Council on Severe Autism hosted a webinar Friday, February 19, 2021 titled “What is Wrong with FC.” Speakers Howard Shane, James Todd, Ralf Schlosser, and Janyce Boynton will be discussing Augmentative and Alternative Communication, evidence-based v. non-evidence-based methods, the ideomotor phenomenon, and Facilitated Communication (history, human rights, and harms). A recording of this webinar is available here.