Materials for Reporters

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.

Auerbach, D. (2015, November 12). Facilitated communication is a cult that won’t die.

This is a broad and in-depth review of the background of FC, the scientific research discrediting it, and the harms resulting from its use. The author discusses reasons for its persistence despite being debunked by science, and concerns that it is actively being pushed into public schools and other settings.

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.”

Chen, J. and Nankervis, K. (2015, February 3). Stolen voices: Facilitated communication is an abuse of human rights. Evidence-Based Communication Assessment and Intervention, 8 (3), 151-156. DOI: 10.1080/17489539.2014.1001549

“Drawing upon our experience as practitioners in the field of intellectual and developmental disability, we offer the view that it is important to argue against FC from a human rights perspective using the United Nations Convention on the Rights of Persons with Disabilities (2006). Put simply, FC is an abuse of human rights.”

Dillon, K. (1993). Facilitated Communication, Autism, and Ouija. The Skeptical Inquirer, 17 (3), 281-287.

The author elaborates upon the parallels between Ouija and FC.

Elliott, J. (2016, July 20). The battle over a controversial method for autism communication. The Atlantic.

Provides an overview of evidence debunking FC and related prompting methods, along with a discussion of reasons for the persistence of such techniques. The author concludes: “The unknowns of autism often move parents and families of autistic individuals in a swirl of powerful guilt, uncertainty, and fear. But that swirl also involves hope—hope that beneath a child’s autistic symptoms is a child yearning to communicate with the world. FC’s offer to fulfill that hope is what gives the practice its power, despite compelling scientific evidence against its ability to deliver.”

Emory Health Sciences. (2015, February 26). Why debunked autism treatment fads persist. Science Daily.

Summary of an article by(lead author)Scott Lilienfeld and others: The authors examine “a number of potential reasons for the surprising persistence of FC and other autism fads. They note that the inherent difficulties in treating autism may give rise to an understandable desire for quick fixes of many kinds. Lilienfeld and his colleagues underscore the pressing need for experts in the autism field to better educate the public about not only what works for the condition, but what does not.”

French, C., and Marshall, M. (2018, February 5). Why communication from a locked in child is a miracle we must question. The Guardian.

This article explores the claims of unexpected literacy skills in a young man with disabilities using an “eye gazing” system closely related to facilitated communication. The authors urge caution in accepting unproven claims of literacy from proponents promoting the technique.

Ganz, J., Katsiyannis, A., Morin, K.L. (2018). Facilitated communication: The resurgence of a disproven treatment for individuals with autism. Intervention in School and Clinic, 54 (1), 52-56. DOI: 10.1177/1053451217692564

From the abstract: “A description of the technique is provided along with a summary of the research that disproves facilitated communication. Legal issues related to the use of facilitated communication in school settings are outlined along with recommendations for critically evaluating any potential intervention or treatment.”

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.

Hoffmann, T. (2018, August 7). Ouija board study highlights ineffective treatment for autism. Science Nordic.

This article discusses a study which revealed that people can unconsciously create meaningful words and sentences, while being utterly convinced that the messages were created not by them, but by some other entity. This conclusion has implications for individuals using facilitated communication.

Lilienfeld, S., et.al. (2014). The Persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example. Evidence-Based Communication Assessment and Intervention, 8 (2), 62-101. DOI: 10.1080/17489539.2014.976332

From the abstract: “Although FC was scientifically discredited by the mid-to-late 1990s, data we review demonstrate that it is still frequently administered in clinical and educational settings. We examine evidence for FC’s (a) continued use as an intervention for autism, (b) persistence in academic and institutional settings, (c) popularity in online and print sources, (d) promotion in the media, and (e) ongoing risk to caregivers accused of sexual abuse. We analyze the sources of these troubling developments, explore their ethical implications, and offer recommendations for addressing the spread of FC and other fad interventions.”

Novella, S. (2018, March 14). Facilitated communication rears its ugly head again. Science-Based Medicine.

Steven Novella notes: '“The deeper lesson for the professional community is the harm that is done from adopting even promising methods too soon. What tends to happen is that they become embedded in the infrastructure. Before long there are institutes dedicated to the technique, seminars, specialists, even continuing education credits. The trappings of legitimacy can be acquired very quickly. A new generation trained in the technique, and convinced by confirmation bias and their own anecdotes, may find it difficult to abandon the technique later. “

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.

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.

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.”

Sobel, S. Facilitated communication redux: Persistence of a discredited technique. Skeptic, 23 (3).

An overview of the history of FC, the evidence discrediting it, harms it can cause, organizational policy statements against its use, and reasons for its persistence. The promotion of FC by a state governmental agency in Vermont is addressed.

Todd, J. T. (2016). Old horses in new stables: Rapid prompting, facilitated communication, science, ethics, and the history of magic, in R. Foxx & J.A. Mulick (Eds). Controversial Therapies for Autism and Intellectual Disabilities: Fad, Fashion, and Science in Professional Practice, 2nd edition, New York, NY: Routledge, pp. 372-409.

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.”

Trembath, D., Paynter, J., Keen, D., and Ecker, U.K.H. (2016) “Attention: myth follows!” Facilitated communication, parent and professional attitudes towards evidence-based practice, and the power of misinformation. Evidence-Based Communication Assessment and Intervention. 

The authors discuss parent and professional attitudes toward evidence-based practice, and the power of misinformation. They conclude: “countering FC requires a comprehensive and concerted effort, which must build awareness, capacity, and resilience within parents, professionals, and organizations to adopt only evidence-based interventions.”

Vyse, S. (2018, April 28). Syracuse, Apple, and autism pseudoscience. Skeptical Inquirer. Retrieved from

This article discusses The Daily Orange’s expose of facilitated communication and Syracuse University’s role in perpetuating the discredited technique. It also discusses Rapid Prompting Method, an FC variant, and its promotion in Apple computer commercials.

Vyse, S. (2015, May 11). Facilitated communication: The fad that will not die. Skeptical Inquirer.

An overview of the debunking of FC, and a discussion of reasons for its persistence, including: renaming and repackaging, media campaigns and support from certain academic quarters. The author also discusses how “new waves of unreason” have provided a boost for the discredited practice of FC.

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.