- Facilitated communication
Facilitated communication (FC) is a process by which a
facilitator supports the hand or arm of a communicatively impaired individual while using a keyboard or other devices with the aim of helping the individual to develop pointing skills and to communicate. Someneurologist s andpsychologist s believe there is a high incidence ofdyspraxia , or difficulty with planning and/or executing voluntary movement, among such individuals, and that this is alleviated by a facilitator's manual support. [Bauman, 1993; Biklen, 1990 and 1997; Gernsbacher et al., "Infant motor dyspraxia as a predictor of speech in childhood autism." (available [http://psych.wisc.edu/lang/presentation-text.html online] ; retrieved 5 February 2007)] Proponents of FC suggest that some people withautism and moderate and profoundmental retardation 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 reviewed scientific studies concluded that the typed language output attributed to the clients was directed or systematically determined by the therapists who provided facilitated assistance. However, several peer-reviewed scientific studies found instances of valid FC, and some FC users have reportedly gone on to type independently.
History
Facilitated communication first drew attention in
Australia in1977 , when Rosemary Crossley, teacher at St. Nicholas Hospital, claimed to have produced communication from 12 children diagnosed withcerebral palsy and other handicaps and argued that they possessed normal intelligence. These findings were disputed by the hospital and theHealth Commission of Victoria ; however, in 1979 one of Crossley's students, Anne McDonald, left the hospital after successfully fighting an action forHabeas Corpus in theSupreme Court of Victoria . 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. cite book |author=McDonald, Anne; Crossley, Rosemary |title=Annie's Coming Out |publisher=Penguin (Non-Classics) |location= |year=1984 |pages= |isbn=0-14-005688-2 |oclc= |doi=]Facilitated communication gained further exposure when
Arthur Schawlow , a Nobel-prize-winning physicist, 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 theStanford University website:"They became champions of the technique and were largely responsible for introducing it to the United States, where it remains controversial."cite web |url=http://news-service.stanford.edu/news/1999/may5/schawlowobit-55-a.html |title=Arthur Schawlow, Nobel laureate and co-inventor of the laser, dies: 4/99 |accessdate=2007-12-31 |format= |work=]In 1989
Douglas Biklen , a sociologist and professor of special education atSyracuse University , investigated Rosemary Crossley's work in Australia. She was then Director of DEAL (Deal Communication Centre),cite web |url=http://home.vicnet.net.au/~dealcc/facil.htm |title=Facilitated Communication Training - DEAL COMMUNICATION CENTRE |accessdate=2007-12-31 |format= |work=] Australia's first federally-funded centre for augmentative communication. Biklen helped popularize the method in the USA and created the Facilitated Communication Institute at Syracuse University.cite web |url=http://suedweb.syr.edu/thefci/ |title=Facilitated Communication Institute: Syracuse University |accessdate=2007-12-31 |format= |work=]After starting to use the method in Syracuse, 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
disabled children, 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).cite web |url=http://suedweb.syr.edu/thefci/trainingstandards.htm |title=FACILITATED COMMUNICATION TRAINING STANDARDS |accessdate=2007-12-31 |format= |work=] 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 autistic children 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.cite journal |author=Botash AS, Babuts D, Mitchell N, O'Hara M, Lynch L, Manuel J |title=Evaluations of children who have disclosed sexual abuse via facilitated communication |journal=Arch Pediatr Adolesc Med |volume=148 |issue=12 |pages=1282–7 |year=1994 |pmid=7951807 |doi=] In late 1993, a Frontline (PBS) documentary highlighting these concerns was televised;cite web |url=http://www.pbs.org/wgbh/pages/frontline/programs/transcripts/1202.html |title=FRONTLINE: previous reports: transcripts: prisoners of silence | PBS |accessdate=2007-12-31 |format= |work=] FC proponents responded with criticisms of negative
bias .cite web |url=http://suedweb.syr.edu/thefci/2-1sch.htm |title=IS FACILITATED COMMUNICATION REAL? |accessdate=2007-12-31 |format= |work=]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 1990's, 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 professional organizations do not support the use of Facilitated Communication due to the lack of scientific validity or reliability. These organizations include the American Speech-Language-Hearing Association, Association for Behavioral Analysis (ABA), American Academy of Child and Adolescent Psychiatry, and the American Association on Mental Retardation. ABA 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.
References: * American Academy of Child and Adolescent Psychiatry (1993, October). Policy statement of facilitated communication. AACAP Newsletter, February 1994.http://www.aacap.org/cs/root/policy_statements/facilitated_communication * American Academy of Pediatrics (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433. * American Association on Mental Retardation (1994). AAMR Board approves policy on facilitated communication. AAMR News & Notes, 7 (1), 1. * American Psychological Association (1994). Resolution on facilitated communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California.www.apa.org/about/division/cpmscientific.html * American Speech-Language-Hearing Association. (1995, March). Position statement on facilitated communication. ASHA, 37, 22.(http://www.asha.org/docs/html/PS1995-00089.html) * Association for Behavior Analysis. (1995). Statement on facilitated communication. ABA Newsletter, 18 (2).(www.pbsaba.org/docs/ABAStatementFC.pdf) *The Association for Science in Autism Treatment: asatonline.org/resources/treatments/facilitated.htm.
Research
In these negative 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. However, some studies did report positive or mixed results (i.e., valid authorship by FC users; e.g. Calculator and Singer, cite journal |author=Simon EW, Toll DM, Whitehair PM |title=A naturalistic approach to the validation of facilitated communication |journal=J Autism Dev Disord |volume=24 |issue=5 |pages=647–57 |year=1994 |pmid=7814312|doi=10.1007/BF02172144] cite journal |author=Vázquez CA |title=Brief report: a multitask controlled evaluation of facilitated communication |journal=J Autism Dev Disord |volume=24 |issue=3 |pages=369–79 |year=1994 |pmid=8050989|doi=10.1007/BF02172234] and much debate ensued among scholars and clinicians ["Literature Review: "Mental Retardation", 32(4) -- Exchange of opinion on the risks and benefits of faciltated communication." Drake, Steve. "Facilitated Communication Digest" (vol. 3, no. 1), November 1994. [http://suedweb.syr.edu/thefci/mrrev.htm copy online] , accessed 3 May 2008.] . In the opinions of proponents of the method, [cite book |author=Biklen, Douglas |title=Autism and the myth of the person alone |publisher=University Press |location=Cambridge, Eng |year=2005 |pages= |isbn=0-8147-9927-2 |oclc= |doi=] 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 (e.g. cite web |url=http://seab.envmed.rochester.edu/jaba/articles/1995/montee-full.html |title=Facilitated Communication - Montee et al. (1995) |accessdate=2007-12-31 |format= |work=] cite journal |author=Vázquez CA |title=Failure to confirm the word-retrieval problem hypothesis in facilitated communication |journal=J Autism Dev Disord |volume=25 |issue=6 |pages=597–610 |year=1995 |pmid=8720029|doi=10.1007/BF02178190] 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.cite web |url=http://suedweb.syr.edu/thefci/5-3bik.htm |title=Excerpts from Contested Words, Contested Science |accessdate=2007-12-31 |format= |work=] cite book |author=Cardinal, Donald N.; Biklen, Douglas |title=Contested words, contested science: unraveling the facilitated communication controversy |publisher=Teachers College Press |location=New York |year=1997 |pages= |isbn=0-8077-3601-5 |oclc= |doi=]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; [McDonald, A. (1993). "I’ve Only Got One Life and I Don’t Want to Spend It All Proving I Exist." Communicating Together, 11(4), 21-22] Crossley and McDonald, 1984; ] and Dwyer, 1996cite web |url=http://home.vicnet.net.au/~dealcc/DwyerB.htm |title=ACCESS TO JUSTICE FOR PEOPLE WITH SCI - Chapter Two |accessdate=2007-12-31 |format= |work=] ). [Dwyer, Joan. (1996). "ACCESS TO JUSTICE FOR PEOPLE WITH SEVERE COMMUNICATION IMPAIRMENT". The Australian Journal of Administrative Law, February 1996, 3(2), 73-119. ( [http://home.vicnet.net.au/~dealcc/DwyerB.htm online copy] )] Proponents also state that a handful of controlled studies supporting authorship by FC users have been published in journals.cite journal |author=Cardinal DN, Hanson D, Wakeham J |title=Investigation of authorship in facilitated communication |journal=Ment Retard |volume=34 |issue=4 |pages=231–42 |year=1996 |pmid=8828342 |doi=]
Harvard University psychologist Daniel Wegner has argued that facilitated communication is a striking example of theideomotor effect ,cite web |url=http://www.quackwatch.org/01QuackeryRelatedTopics/ideomotor.html |title=How People Are Fooled by Ideomotor Action |accessdate=2007-12-31 |format= |work=] the well-known phenomenon whereby individuals' expectations exert unconscious influence over their motor actions ( [http://www.wjh.harvard.edu/~wegner/pdfs/Wegner%20Fuller%20&%20Sparrow.pdf Daniel Wegner] ). [cite journal |author=Wegner DM, Fuller VA, Sparrow B |title=Clever hands: uncontrolled intelligence in facilitated communication |journal=J Pers Soc Psychol |volume=85 |issue=1 |pages=5–19 |year=2003 |pmid=12872881 |doi= |url=http://content.apa.org/journals/psp/85/1/5] 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. [Donnellan, A.M. & Leary., M.R. "Movement Differences and Diversity in Autism/Mental Retardation: Appreciating and Accommodating People with Communication Challenges." DRI Press, (1995) ISBN 1-886928-00-2] [cite web |url=http://www.autcom.org/rethinking.html |title=autcom.org |accessdate=2007-12-31 |format= |work=]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.cite web |url=http://suedweb.syr.edu/thefci/8-1rub1.htm |title=8-1rub1 |accessdate=2007-12-31 |format= |work=] 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. cite journal |author=Weiss MJ, Wagner SH, Bauman ML |title=A validated case study of facilitated communication |journal=Ment Retard |volume=34 |issue=4 |pages=220–30 |year=1996 |pmid=8828341 |doi=] cite journal |author=Cardinal DN, Hanson D, Wakeham J |title=Investigation of authorship in facilitated communication |journal=Ment Retard |volume=34 |issue=4 |pages=231–42 |year=1996 |pmid=8828342 |doi=] 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 Communication has done theoretical research about facilitated communication.cite journal |author=von Tetzchner S |title=Historical issues in intervention research: hidden knowledge and facilitating techniques in Denmark |journal=Eur J Disord Commun |volume=32 |issue=1 |pages=1–18 |year=1997 |pmid=9135710 |doi=] In his opinion "The existing evidence clearly demonstrates that facilitating techniques usually led toautomatic writing , displaying the thoughts and the attitudes of the facilitators." [cite book |author=Harald Martinsen; Tetzchner, Stephen von |title=Introduction to Augmentative and Alternative Communication: Sign Teaching and the Use of Communication Aids for Children, Adolescents and Adults with Developmental Disorders |publisher=Whurr Publishers, Ltd |location= |year=2000 |pages=177 |isbn=1-86156-187-3 |oclc= |doi=]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."Calculator, S.N. (1999). Look Who’s Pointing Now: Cautions Related to the Clinical Use of Facilitated Communication. Language, Speech, And Hearing Services In Schools, 30 (Octovber), 408–414 ( [http://www.asha.org/NR/rdonlyres/9065242C-5CFF-4313-BD85-F7FAF1AC414E/0/11084_1.pdf online version] ; PDF)]
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." [cite journal |author=Mostert MP |title=Facilitated communication since 1995: a review of published studies |journal=J Autism Dev Disord |volume=31 |issue=3 |pages=287–313 |year=2001 |pmid=11518483 |doi=10.1023/A:1010795219886|url=http://www.kluweronline.com/art.pdf?issn=0162-3257&volume=31&page=287]
In March of 2007, Scott Lilienfeld included facilitated communication on a list of treatments that have the potential to cause harm in clients, published in the APS journal "Perspectives on Psychological Science". [Lilienfeld, S. O. (2007). Psychological treatments that cause harm. "Perspectives on Psychological Science", "2", 53-70.]
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.cite web |url=http://suedweb.syr.edu/thefci/2-2bik.htm |title=LEARNING ABOUT INDEPENDENT TYPING FROM PEOPLE WORKING TO ACHIEVE IT |accessdate=2007-12-31 |format= |work=] Skeptics of FC do not agree that this definition of independence suffices because of the possibility of influence by the facilitator. For example,
Sue Rubin , an FC user featured in the autobiographical documentary "Autism Is A World", [cite web |url=http://www.stateart.com/productions/disabilities/autismisaworld/synopsis.asp |title=stateart.com |accessdate=2007-12-31 |format= |work=] reportedly types without anyone touching her; however, she reports that she requires a facilitator to hold the keyboard and offer other assistance. cite web |url=http://suedweb.syr.edu/thefci/8-1rub2.htm |title=8-1rub2 |accessdate=2007-12-31 |format= |work=] 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",cite web |url=http://myclassiclifefilm.com |title=myclassiclifefilm.com |accessdate=2007-12-31 |format= |work=] 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), [Broderick, A.A., and C. Kasa-Hendrickson (2001). "SAY JUST ONE WORD AT FIRST": The Emergence of Reliable Speech in a Student Labeled With Autism." JASH, 26(1), 13-24 (ERIC [http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ629415&ERICExtSearch_SearchType_0=no&accno=EJ629415 link] )] andLucy Blackman , author of the autobiography "Lucy's Story" (Blackman, 2001).cite book |author=Mirenda, Pat; Beukelman, David R. |title=Augmentative and Alternative Communication: Management of Severe Communication Disorders in Children and Adults |publisher=Paul H Brookes Pub Co |location= |year=1998 |pages= |isbn=1-55766-333-5 |oclc= |doi=] [cite book |author=Tony Attwood; Lucy Blackman |title=Lucy's Story: Autism and Other Adventures |publisher=Jessica Kingsley Publishers |location=London |year=2001 |pages= |isbn=1-84310-042-8 |oclc= |doi=] Douglas Biklen has compiled the reports from three FC users about their progress toward independent typing.cite web |url=http://suedweb.syr.edu/thefci/2-2bik.htm |title=LEARNING ABOUT INDEPENDENT TYPING FROM PEOPLE WORKING TO ACHIEVE IT |accessdate=2007-12-31 |format= |work=]
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