Facilitated communication, a highly discredited technique meant to be a communication aid for individuals with autism, severe intellectual disabilities, and others with complex communication needs, is still a subject of controversy as its practice continues (Lilienfeld et al., 2014). Despite the negativity surrounding the communication procedure, it is still crucial to understand precisely the methods and procedures that researchers used in undertaking studies on facilitated communication. Autism Spectrum Disorder is a developmental disorder. Autism is only diagnosed through observation of behavior, as there is no medical test for it. That is why it is mostly diagnosed in children of ages 1 to 3 years and but has lifelong impact on the patients. Autism interferes with the development of a child’s social and communication skills. The severity of the disorder varies as some have recovered while some enter adulthood still not able to live independently. Other than speech therapy or behavioral interventions, there is no known cure of autism. However, research has proved that early intervention treatments can help improve a child’s development. Thus, parents and society as a whole are encouraged embrace these intervention treatments. As a result, relevant professionals have been devising techniques to better attune to the needs of children with autism thus the development of facilitated communication.
Scholars have traced the roots of Facilitated communication (FC) to 1977 in Melbourne, Australia at the St. Nicholas Hospital. A staff member, Rosemary Crossley developed FC to draw out communication from nonverbal patients. It involves a facilitator supporting the arm of the communication partner (the person with the disability) as they point out letters on a keyboard or other communication devices (Saloviita et al., 2014). From Melbourne, FC gained prominence in the United States through Douglas Biklen, a sociologist and professor of Special Education at Syracuse University. In his 1990 article in the Harvard Educational Review, he tells of how he observed 21 individuals who could not otherwise communicate, had typed their thoughts and fully conversed with him. Soon, Biklen and other proponents incorporated FC into the academic and clinical mainstreams (Lilienfeld et al., 2014).
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While FC was gaining prominence in the early 90s, researchers began to observe certain behaviors that began the questions on its validity. For instance, the children with autism or other communication disabilities were not paying attention to the keyboard or screen. Some were dozing off or exhibiting a degree of restlessness. Additionally, the researchers noticed the facilitators forcefully trying to keep the arms of the children on the keyboard when they wanted to take it off. When scholars started digging further into the issue, they discovered cases where the children could not provide basic information like writing their names in the absence of the facilitator. Studies later criticized the process claiming that the communication produced is from the facilitator and not the person with autism. However, the facilitator is completely unaware of their role as the movement is from ideomotor responses. The way a group of teenagers with an Ouija board would each swear they did not move the planchette, is similarly how a facilitator may believe that the message is from the communication partner.
Further research has highlighted additional negative effects arising from the use of FC. The reliance of the individual with disabilities on the facilitator creates a dependency relationship that has proved detrimental. There has been reports of sexual abuse gotten from FC messages only for the judicial system to prove false (Lilienfeld et al., 2014). Such false grave accusations stem from reliance on someone else to relay a message, which further fueled the opposition against FC. Considering the various studies proving its inefficiency, the American Psychological Association (APA) in 1994 issued a resolution against FC stating that there was no scientifically demonstrated support for its efficacy (Lilienfeld et al., 2014). Apart from APA, several other institutions have made statements opposing FC over the years.
Saloviita et al. (2014) conducted a study in a small Finnish city, to determine the authorship of messages produced through FC. They conducted a series of tests on a sample 11 children with intellectual disabilities all having used FC for 1-3 years. The tests were object-naming, picture naming, describing a picture, reading, writing one’s name and independent pointing. In object naming, the researchers asked the facilitators to close their eyes so that they were not able to see the object shown to the participants and then repeated the test in an open condition where they could see the object. The study applied the same technique on reading where a word on a piece of paper was presented to the participant who was required to read it and write it through facilitation without the facilitator having seen the word. On the picture naming and describing a picture tests, the researchers presented the facilitators with different pictures from the ones shown to the participants ensuring that no group saw what the other were seeing. Subsequently, the participants had to write their names while the facilitators had their eyes closed. The participants failed all the tests, as they could not correctly produced the desired communication except for the open tests. The research concluded with strong evidence that the facilitator produced the messages and that the use of FC actually worsened the participants’ communication. The research is one of many others (Lilienfeld et al., 2014) that arrived at the same results.
The proponents of FC have conducted research as well defending the use of the method. Sipila and Maatta (2011) undertook research in Finland to investigate whether Facilitated Communication method supports people with autism from the perspective of the facilitators. The study collected data using semi-structured interviews on a sample of 11 facilitators. The results showed that the facilitators believed in FC form its ethical justification that every time there emerged possibilities to communicate the disabled could attain ethical dignity. Contradicting the opponents who used tests to test for the validity of the method, the facilitators claimed that the assistees were sensitive to a doubtful attitude and atmosphere as they refused to communicate when in these environs. Thus, it was difficult to obtain objective results in these research-controlled atmospheres that led to the contradictory scientific conclusions.
The study also notes that the facilitators were aware of the resistance that FC faced and they question the knowledge and practical opinion of those who were doubtful. As the practitioners of the technique, they claim that it was not easy to see who was leading the movement when the facilitation was very strong in the communication partner’s hand. What they actually felt was the child’s hand moving. The allegation that it was the facilitator based on just seeing was therefore untruthful. The observation that the communication partners were also very willing to enter the communication situation proved to the facilitators that the technique was indeed a communication way for them. The facilitators in this study as to other proponents of FC justified it to the positive changes in the behavior of the children with autism. They allege that the children could communicate better, had reduced the instances of challenging behavior, had a more cheerful attitude and showed development associated to maturity (Sipila & Maatta, 2011). The inclusiveness of the child to the family is especially what pushes most parents to opt for this method.
By concluding FC as non-scientific, the anti-FC research studies completely blocks the method from development. Communication is a development and the proponents of FC believe that the method can develop to effectiveness. The facilitators in the pro-FC admit that FC does not exhaustively make the communication problems disappear (Sipila & Maatta, 2011). They mentioned using FC together with other methods such as picture folders, support signs, gestures and other visual aids. However, shutting down FC prevents it from any contribution to aid the needs of the disabled.
The sample that the pro-FC research used comes under scrutiny in giving biased results. The study makes use of facilitators of the method, who obviously support it given that they are practitioners. The possibility of a biased response from the interviews in quite high in such a situation. Unlike the first research where third party nonparticipants observed the process, the second relies on responses from facilitators who are part of the communication process. As most scientific research have claimed, the proponents of FC talk of its success on evidence based only on opinion. They point out cases where the individuals with communication disabilities were able to transition to typing independently (Lilienfeld et al., 2014). Regardless of this development, it still does not prove the authorship of the messages assisted by the facilitator. The expectation that the results against FC would gain more support is thus obvious.
The most outstanding methodological problem with the pro-FC research studies is its disregard in objective data especially in the case of autism. Proponents of FC believe that the communication partner has only a limitation to expression but actually possesses normal levels of intelligence. That if it was possible to read the minds of the autistic, they would exhibit cognitive skills as good as the normal children. Research on autism however terms it as a neurological problem whose effect cannot be simply redeemed by physical guidance. There exists a small minority of individuals with autism who display astounding intellective talents. They display skills such as calendar calculation and extraordinary geographical knowledge among others. The presence of these savants has especially driven the proponents of FC to believe that with the continued use of the technique, the community will discover more savants (Lilienfeld et al., 2014). Such claims explain why despite the ruling of FC as non-scientific, parents and caregivers still employ and swear by this technique.
Despite its label as a pseudoscience, FC still exists. The proponents of FC are not giving up on this crusade. Especially on the fact that some of the proponents are influential individuals whose opinion is important and weighty to the masses. Jenny McCarthy, an American TV personality, has documented her journey in finding a cure for her son’s autism (McCarthy, 2007). She claims that vaccines caused her son’s autism and is verbal of this conclusion. She spreads this crusade to her audience despite scientific studies providing evidence-based research disputing this fact. On such a case, it is challenging for the relevant boards to instigate compliance based on scientific conclusion if the people’s role model is claiming otherwise.
The same is with the case of Douglas Biklen, one of the earliest proponents of this technique. Biklen has maintained his support for FC despite the criticism it receives (Lilienfeld et al., 2014). He disputes the tests as placing the individuals with autism in a confrontational atmosphere thus interfering with their confidence to communicate. Research has however disputed the argument an example being the one conducted by Saloviita et al. (2014). In the study, the researchers attempted to maintain the procedures to imitate typical communication therapy sessions, in which the students with disabilities regularly participated. They used familiar partners identified by the school as skilled facilitators; and a staff member familiar to the participants performed the test activities. The testing activities were also conducted in a familiar environment, and no sign of test anxiety yet still the results proved presence of facilitators influence on the messages (Saloviita et al., 2014). Given that he is a professor and his success on the Facilitated Communication Institute now the Institute on Communication and Inclusion (ICI) (https://ici.syre.edu/) which provides sponsorship to groups that promote FC, it is easy for desperate parents to believe every word he say (Lilienfeld et al., 2014).
FC is one in many other fad interventions that its practitioners believe helps when it does not. The relevant bodies should devise ways that go beyond only scientifically disapproving such methods, to combating their practice. Lilienfeld et al. (2014) suggests debiasing techniques to demonstrate to students (would-be facilitators) of how easily they can be fooled by bogus interventions. Instead of just disputing FC, they should relate of the other scientific techniques that actually work. Research should be conducted in the effective methods so that when debunking FC, the opponents provide alternatives to the caregivers (Lilienfeld et al., 2014). Methods such as the use of Speech Generating Devices (SGD) targets skills such as initiation, expressive language, gestures, and pragmatics. The skills sets apart this method from FC in the sense that the person with ASD will not always depend on someone else to communicate as with the case of facilitators in FC. The Picture Exchange Communication System (PECS) entails the people with communication disability using pictures to communicate. In this method, the individual approaches the other person with a picture of the desired item, thus, it also enhances initiation. Information is key. Scientists should communicate such effective methods; consult with autism societies so that they provide scientifically accurate information on the websites as well as other promotional materials.
Discussion Questions
Given the available success stories from the proponents FC, is it right to still dismiss it for its negative scientific evidence?
Is there hope for a time where FC and other fad interventions would completely be wiped out?
Other than the recommended measures, what other steps can we take to ensure FC and other fad interventions are not practiced.
References
Lilienfeld, S. O., Marshall, J., Todd, J. T., & Shane, H. C. (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.
McCarthy, J. (2007). Louder than Words: A Mother's Journey in Healing Autism . New York: Dutton. doi: 0525950117, 9780525950110
Saloviita, T., Leppänen, M., & Ojalammi, U. (2014). Authorship in facilitated communication: An analysis of 11 cases. Augmentative and Alternative Communication , 30 (3), 213-225.
Sipilä, A. K., & Määttä, K. (2011). Can the Facilitated Communication Method Support Autistic People, According to Facilitators' Opinions?. Psychology of Language and Communication , 15 (1), 1-26.
