Facilitated communication (FC) is a process by which a
facilitatorA facilitator is someone who helps a group of people understand their common objectives and assists them to plan to achieve them without taking a particular position in the discussion. The facilitator will try to assist the group in achieving a consensus on any disagreements that preexist or emerge...
supports the hand or arm of a communicatively impaired individual while using a
keyboardIn computing, a keyboard is an input device, partially modeled after the typewriter keyboard, which uses an arrangement of buttons or keys, to act as mechanical levers or electronic switches. A keyboard typically has characters engraved or printed on the keys and each press of a key typically...
or other devices with the aim of helping the individual to develop pointing skills and to communicate. Some neurologists and
psychologistA psychologist is someone who studies the human mind and behavior. Research psychologists study human perception, cognition, attention, emotion, motivation, personality, behavior and interpersonal relationships...
s believe there is a high incidence of
dyspraxiaDevelopmental dyspraxia is one or all of a heterogeneous range of development disorders affecting the initiation, organization, and performance of action...
, or difficulty with planning and/or executing voluntary movement, among such individuals, and that this is alleviated by a facilitator's manual support. Proponents of FC suggest that some people with
autismAutism is a disorder of neural development that is characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism involves many parts of the brain; how this occurs is not well understood...
and moderate and profound
mental retardationMental retardation is a generalized disorder, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18...
may have "undisclosed literacy", or the capacity for other symbolic communication, consistent with higher intellectual functioning than has been presumed.
The procedure is controversial, since a majority of
peer reviewPeer review is the process of subjecting an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field. Peer review requires a community of experts in a given field, who are qualified and able to perform impartial review...
ed scientific studies conclude that the typed language output attributed to the clients is directed or systematically determined by the therapists who provide facilitated assistance. Some peer-reviewed scientific studies have indicated instances of valid FC, and some FC users have reportedly gone on to type independently.
History
Facilitated communication first drew attention in
AustraliaAustralia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the continental mainland , the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans...
in 1977, when
Rosemary CrossleyRosemary Crossley AM is a bestselling Australian author and advocate for disability rights and facilitated communication.-Authorship and advocacy:...
, teacher at St. Nicholas Hospital, claimed to have produced communication from 12 children diagnosed with
cerebral palsyCerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development....
and other disabilities and argued that they possessed normal intelligence. These findings were disputed by the hospital and the Health Commission of Victoria; however, in 1979 one of Crossley's students,
Anne McDonaldAnne McDonald is an Australian author and an activist for the rights of people with communication disability.Anne McDonald was born in Seymour, a small Australian town, in 1961. As a result of a birth injury she developed severe athetoid cerebral palsy. She was diagnosed as having severe...
, left the hospital after successfully fighting an action for
Habeas CorpusHabeas corpus is a legal action, or writ, through which a person can seek relief from the unlawful detention of him or herself, or of another person. It protects the individual from harming him or herself, or from being harmed by the judicial system...
in the
Supreme Court of VictoriaThe Supreme Court of Victoria is the superior court for the State of Victoria, Australia. It was founded in 1852, and is a superior court of common law and equity, with unlimited jurisdiction within the state...
. After continuing controversy the Victorian Government closed the hospital in 1984-5 and rehoused all the residents in the community. Crossley and McDonald wrote a book about the experience called "Annie's Coming Out" in 1984.
Facilitated communication gained further exposure when Nobel laureate Arthur Schawlow used it with his autistic son in the early 1980s and felt that it was helpful. His experience and its effects on the disability community are described on the
Stanford UniversityThe Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university located in Stanford, California, United States...
website:
They became champions of the technique and were largely responsible for introducing it to the United States, where it remains controversial.
In 1989
Douglas BiklenDouglas Paul Biklen is an American educator best known for promoting the controversial theory of "facilitated communication", an augmentative and alternative communication technique for people with communication impairments, particularly autism.Biklen learned of the theory of facilitated...
, a sociologist and professor of special education at
Syracuse UniversitySyracuse University is a private research university located in Syracuse, New York, U.S.A.. It was founded as a university in 1870, but its roots can be traced back to a seminary founded by the Methodist Episcopal Church in 1832 which eventually became Genesee College...
, investigated Rosemary Crossley's work in Australia. She was then Director of DEAL (Deal Communication Centre), Australia's first federally-funded centre for
augmentative communicationAugmentative and alternative communication is communication for those with impairments or restrictions on the production or comprehension of spoken or written language.-Definition :...
. Biklen helped popularize the method in the USA and created the Facilitated Communication Institute at Syracuse University.
After starting to use the method in
SyracuseSyracuse is a city in and the county seat of Onondaga County, New York, United States, and the fifth most populous city in the state. At the 2000 census, the city population was 147,306, and its metropolitan area had a population of 732,117. It is the economic and educational hub of Central New...
, Biklen reported startling results in which students with severe autism were said to be producing entire paragraphs of clarity and intellect. This produced an explosion of popularity; the method spread across the USA— especially due to its seeming success with people with autism. Facilitated communication was strongly embraced by many parents of children with disabilities, who hoped that their children were capable of more than had been thought. (Most of the foregoing discussion is referenced in Jacobson et al., 1995).
Nevertheless, serious questions regarding FC soon began to surface. For example, some autistic FC users appeared not to be looking at the keyboard while typing (which is contrary to training standards for FC). Still others used vocabulary that was apparently beyond their years and/or education, many producing poetry of varying complexity. A concern arose when some of the communications accused the parents of children with autism of severe sexual and/or physical abuse. Not all such allegations were proven true. However, some sexual abuse allegations made via FC have been found to be valid. In late 1993, a Frontline (PBS) documentary highlighting these concerns was televised; FC proponents responded with criticisms of negative
biasBias is a term used to describe a tendency or preference towards a particular perspective, ideology or result, especially when the tendency interferes with the ability to be impartial, unprejudiced, or objective.. In other words, bias is generally seen as 'one-sided'. The term biased is used to...
.
Around the same time, controlled studies were done on the method, most of which reported that it was the facilitator who was unconsciously producing the communication. By the late 1990s, FC had been discredited in the eyes of most scientists and professional organizations, with some calling it pseudoscientific. FC retained acceptance in some treatment centers in North America, Europe and Australia.
Current position statements of certain professional and/or advocacy organizations do not support the use of Facilitated Communication due to their objections that it lacks scientific validity or reliability. These organizations include the American Speech-Language-Hearing Association, Association for Behavior Analysis International (ABAI), American Academy of Child and Adolescent Psychiatry, and the American Association on Mental Retardation. ABAI calls FC a "discredited technique" and warns that "its use is unwarranted and unethical."
The Association for Science in Autism Treatment reviewed the research and position statements and concluded that the messages typed on the communication device were controlled by the facilitator, not the individual with autism, and FC did not improve their language skills. Therefore, FC was reported to be an "inappropriate intervention" for individuals with autism spectrum disorders.
TASHTASH is an international advocacy association of people with disabilities, their family members, other advocates, and people who work in the disability field. The organization's full name is The Association for Persons with Severe Handicaps. TASH operates as a 501 non-profit organization...
(2000) stated: "The question of authorship can become particularly controversial when the subject of what has been communicated concerns sensitive issues ... (TASH) encourages rigorous and ongoing training for people who decide to become facilitators; encourages careful, reflective use of facilitated communication; encourages facilitators to work in collaboration with individuals with severe disabilities to find ways of monitoring authorship when using facilitation."
The
Autism National CommitteeThe Autism National Committee is an American advocacy association of autistic people and their allies. Autcom operates as a 501 non-profit organization and was founded in 1990...
(AutCom) in 2008 issued a position paper in favor of FC, stating: "Autcom criticizes attempts to dismiss FC on the basis of flawed studies that are poorly designed and/or whose results are incorrectly extrapolated to the entire population of FC users. In particular, we reject over-generalized claims that allege or imply that merely because FC is not valid for some people under some circumstances, FC is not valid for any person under any circumstances." Autcom also acknowledges that facilitator influence is real, and argues that while every effort should be made to avoid it, it is possible for both facilitator influence and genuine, FC-user-authored communication to occur in a given conversation.
Research
In the majority of controlled studies, practitioners were unintentionally cueing the facilitated person as to which letter to hit, so the resulting letter strings did not represent the thoughts of the students but the expectations of the facilitators. Similar responses to possibly unconscious cues were seen in the "Clever Hans" case, where a horse gave correct answers to math problems by watching the reactions of its owner. However, some studies did report positive or mixed results, i.e., valid authorship by FC users, and much debate ensued among scholars and clinicians. In the opinions of proponents of the method, positive results were generally seen in more naturalistic settings, and negative results in more controlled settings.
FC proponents argue that in most of the negative studies, the laboratory setting was itself the confounding variable: i.e., communication is inherently very difficult for autistic people, so they can't necessarily be expected to replicate their successes under unfamiliar or even hostile conditions (e.g., those in which continuance of access to FC was contingent upon passing or failing the test). However, not all negative findings were obtained in clinical settings only; some tests were smoothly embedded in familiar surroundings and daily activities in which participants sometimes did not even know they were tested. In their 1997 book,
Contested Words Contested Science, Biklen and Cardinal (and others) attempt to shed light on why some controlled studies support FC while others do not.
Critics of FC question why people who can give speeches in public and go to college cannot answer a series of simple questions under controlled conditions. Critics also argue that positive results are typically obtained using "qualitative research methods" in which standard experimental controls for bias and subjectivity are weak or non-existent. Proponents argue that FC users have indeed passed controlled tests, often under duress, and as a condition for having access to basic human rights such as educational services and even freedom from institutionalization (e.g., McDonald, 1993; Crossley and McDonald, 1984; and Dwyer, 1996).
Harvard UniversityHarvard University is a private university located in Cambridge, Massachusetts and a member of the Ivy League. Founded in 1636 by the colonial Massachusetts legislature, Harvard is the oldest institution of higher learning in the United States and currently comprises ten separate academic units...
psychologist
Daniel WegnerDaniel M. Wegner is an American social psychologist. He is a professor of psychology at Harvard University and a fellow of the American Association for the Advancement of Science. He is known for his work on mental control and conscious will, and for originating the study of transactive memory and...
has argued that facilitated communication is a striking example of the
ideomotor effectThe ideomotor effect is a psychological phenomenon wherein a subject makes motions unconsciously. As in reflexive responses to pain, the body sometimes reacts reflexively to ideas alone without the person consciously deciding to take action...
, the well-known phenomenon whereby individuals' expectations exert unconscious influence over their motor actions. Even FC users and proponents do acknowledge the possibility of facilitators at times "guiding" users, consciously or unconsciously. Other theorists (Donnellan and Leary, 1995) argue that autism is in significant part characterized by dyspraxia (a movement disorder), and that there exists a synchronistic "dance" to communication in all mammalian social interaction which accounts for the mixed results in validation studies.
Still, the most significant concern with FC was, and remains, that of authorship: the question of who is really doing the typing. Numerous controlled studies have unambiguously established that facilitator influence does occur. FC users and proponents acknowledge this phenomenon; Sue Rubin, an FC user initially diagnosed as mentally retarded but who now attends college and types without physical support (see below), has described her own experience with facilitator influence. FC proponents point out that the fact that cueing occurs under
certain conditions with
certain FC users does not necessarily mean that it
always occurs with
all FC users.
A few controlled studies since 1995 reported instances of genuine authorship by FC users. These studies, and the emergence of independent typing in some FC users, demonstrates in the opinion of proponents that at least in some cases FC is valid but that given the experimental evidence, it is impossible to say just how rare or how common such cases are.
Stephen von Tetzchner, the author of another leading textbook on
Augmentative and Alternative CommunicationAugmentative and alternative communication is communication for those with impairments or restrictions on the production or comprehension of spoken or written language.-Definition :...
has done theoretical research about facilitated communication. In his opinion "The existing evidence clearly demonstrates that facilitating techniques usually led to
automatic writingAutomatic writing is the process or production of writing material that does not come from the conscious thoughts of the writer. Practitioners say that the writer's hand forms the message, with the person being unaware of what will be written....
, displaying the thoughts and the attitudes of the facilitators."
Stephen N. Calculator (1999) says: "Whereas the use of FC proliferated in the United States and elsewhere following initial optimistic reports by Biklen (1990, 1993), Crossley (1992, 1994), and others, this fervor has not been matched by efforts to validate the approach or its theoretical bases. Investigators applying qualitative methods have had their outcomes of success for FC challenged by others in the scientific community who question the appropriateness of such methods in studying FC use. Meanwhile, experimental investigators have focused primarily on questioning and disproving the efficacy of this method. ... Caught in the scientific impasse are individuals with severe communication impairments who may or may not benefit from this approach. They and their families continue to be bombarded with contradictory information, philosophies, and recommendations regarding this method."
Mark Mostert (2001) says: "Previous reviews of Facilitated Communication (FC) studies have clearly established that proponents' claims are largely unsubstantiated and that using FC as an intervention for communicatively impaired or noncommunicative individuals is not recommended."
In March 2007, Scott Lilienfeld included facilitated communication on a list of treatments that have the potential to cause harm in clients, published in the
APSThe Association for Psychological Science , previously the American Psychological Society, is a non-profit organization whose mission is to promote, protect, and advance the interests of scientifically oriented psychology in research, application, teaching, and the improvement of human welfare...
journal
Perspectives on Psychological Science.
Independent Typing
The phrase "independent typing" is defined by supporters of FC as "typing without physical support", i.e., without being touched by another person. Skeptics of FC do not agree that this definition of independence suffices because of the possibility of influence by the facilitator. For example,
Sue RubinSue Rubin is a functionally non-verbal published autistic author who was the subject of the Oscar-nominated documentary Autism Is A World in which she communicated via the controversial communication technique of facilitated communication....
, an FC user featured in the autobiographical documentary
Autism Is A World, reportedly types without anyone touching her; however, she reports that she requires a facilitator to hold the keyboard and offer other assistance.
A number of other people who began communicating with FC have reportedly gone on to be independent typists (i.e., without physical support), and in some cases read aloud the words typed (Biklen
et al., 2005). An example of near-independent typing is shown in Douglas Biklen's documentary of artist Larry Bissonnette,
My Classic Life as an Artist: A Portrait of Larry Bissonnette, produced at Syracuse University. Critics complain that these cases have not been objectively and independently verified; such verification is absent in peer-reviewed studies. However, a few individuals have in fact been cited as independent typists in independently-reviewed publications. Examples include Jamie Burke (Broderick and Kasa-Hendrickson, 2001), and
Lucy BlackmanLucy Blackman is a university educated author with autism. She received a BA in Literary Studies at Deakin University in Geelong, and subsequently a M.A....
, author of the autobiography
Lucy's Story (Blackman, 2001).
Douglas Biklen has compiled the reports from three FC users about their progress toward independent typing.
BeukelmanDavid R. Beukelman, Ph.D., is a speech-language pathologist who specializes in augmentative and alternative communication and communication disorders associated with physical conditions...
and Mirenda, authors of a leading textbook on
Augmentative and Alternative CommunicationAugmentative and alternative communication is communication for those with impairments or restrictions on the production or comprehension of spoken or written language.-Definition :...
, express strong reservations about the use of FC but nonetheless note the existence of "a small group of people around the world who began communicating through FC and are now able to type either independently or with minimal, hand-on-shoulder support. There can be no doubt that, for them, FC 'worked,' in that it opened the door to communication for the first time. ... We include FC here because of Sharisa Kochmeister, Lucy Blackman, Larry Bissonnette, and others who now communicate fluently and independently, thanks to FC. For them, the controversy has ended."
External links
- Controlled studies (and summaries):