Facilitated Communication and Autism

Facilitated communication is very controversial.

Plush Studios/Getty Images
Photo: Plush Studios / Getty Images

Facilitated Communication is a nearly-debunked approach to communication with non-verbal people on the autism spectrum. It involves the use of a keyboard and a "facilitator" whose job is to support the autistic person as they type their responses to questions, thoughts, and concerns. In some cases, the support involves physical touching of the autistic person's arms.

How Supporters of FC Describe the Process

The Syracuse University Department of Education's Institute of Communication and Inclusion continues to teach FC as a legitimate form of communication.

Here is how they describe what they now call "supported typing":

Facilitated Communication (FC) or Supported Typing is a form of alternative and augmentative communication (AAC) in which people with disabilities and communication impairments express themselves by pointing (e.g. at pictures, letters, or objects) and, more commonly, by typing (e.g. in a keyboard). The method involves a communication partner who may provide emotional encouragement, communication supports (e.g., monitoring to make sure the person looks at the keyboard and checks for typographical errors) and a variety of physical supports, for example to slow and stabilize the person’s movement, to inhibit impulsive pointing, or to spur the person to initiate pointing; the facilitator should never move or lead the person.

It often is referred to alternatively as Facilitated Communication Training because the goal is independent typing, nearly independent typing (e.g., a hand on the shoulder or intermittent touch) or a combination of speaking with typing - some individuals have developed the ability to read text aloud and/or to speak before and as they are typing. Typing to communicate promotes access to social interaction, academics, and participation in inclusive schools and communities.

History of Facilitated Communication

Facilitated communication was first conceived of by Australian Rosemary Crossley, an employee of St. Nicholas Hospital in Melbourne, Australia. By the 1980's interest in this approach was growing. If legitimate, FC could potentially "unlock" the minds of nonverbal people, making it possible for them to communicate their thoughts, ideas, and needs.

During the 1990's, great interest in FC led to what seemed like extraordinary outcomes: people with no apparent engagement in the world were suddenly expressing complex thoughts and ideas. In some cases, they were also describing instances of sexual abuse. After much controversy, researchers found that the individuals who were thought to be "communicating" were almost certainly being physically guided by their facilitators.

In 1994, the American Psychological Association officially stated that there was no scientific evidence supporting FC. The American Speech-Language-Hearing Association and American Academy of Pediatrics issued similar statements. Their concerns--that FC could actually do harm--were supported when several autistic individuals, using FC, supposedly claimed they had been raped by their caregivers. After much investigation and heartache, the cases were dismissed.

Despite negative findings and controversy, interest in FC continued. Syracuse University, which had founded a Facilitated Communication Institute, conducted research. Documentaries, including the 2005 Academy Award-nominated Autism Is a World, kept public interest strong. Researchers at Syracuse, as well as the University of Kansas and the University of New Hampshire (among others) continue to research FC with the understanding that it is a legitimate field of study.

The Case Against FC

In general, mainstream practitioners reject FC, and organizations including the American Speech-Hearing-Language Association, the American Psychological Association, and others have specific policies stating that FC is an unproven technique which has the potential to cause more harm than good.

Those people who reject FC claim that the FC facilitator -- who physically supports the arm or hand of the typer -- is, in fact, tapping out his own conscious or unconscious thoughts. Occasionally, those thoughts have included unfounded claims of abuse against parents and caregivers.

To explain the FC phenomenon, some researchers have compared FC to an Ouija board.

An ouija board is a board with letters on it. Two people place their fingers on a marker, and spirits of the dead are supposed to guide their hands to letters on the board, spelling out a message from beyond the grave. Very often a message is, in fact, spelled out -- but research has shown that the users themselves are unconsciously moving their hands.

The Case for FC

Those people who support FC as a real tool for communication with nonverbal individuals on the autism spectrum have done their own research. Most of the time, supporting studies have focused on individual case studies. To prove that the typer is, indeed, typing his own thoughts, they asked questions that the supporter could not possibly answer. In some cases, the typer actually typed out answers that made perfect sense.

The Institute for Communication and Inclusion lists many peer-reviewed case studies like those described above, most dating from the early and mid-1990s when FC was most popular. In addition, a new but similar technique called "Rapid Pointing" has helped raise new interest in the approach. Rapid Pointing is described in detail in Portia Iversen's book Strange Son, and FC can be seen in action in the video Autism: The Musical. 

Should We Try FC?

It is extremely tempting for the parent of a child with nonverbal autism to try FC (or Rapid Pointing). The idea that there is a mind trapped inside your child, just waiting for the tools to emerge, is extraordinarily compelling.

But is it really a good idea to try FC?

While there are certainly organizations and institutions that will provide FC training (including Syracuse University), FC is not a first choice for communication. Before getting involved with FC, it makes sense to try teaching a child with autism to use better-known, better-understood techniques. Some options include picture cards, American Sign Language, electronic tools such as augmentative speech devices, digital pads, and, of course, ordinary (unsupported) typing. Not only are these techniques less controversial, but they're all more widely usable and understood.

If, however, more typical tools have failed, FC may be a possible direction to try. If you do try FC, be sure to investigate the provider and the therapist thoroughly to ensure you're not the victim of a scam.

Sources:

Elliott, James. The battle over a controversial method for autism communication. The Atlantic. July 2016.Institute on Communication and Inclusion. History of supported typing. Syracuse University. Web. 2016

Trembath, D. et al. Attention: myth follows!" Facilitated communication, parent and professional attitudes towards evidence-based practice, and the power of misinformation. Evidence-Based Communication Assessment and Intervention Vol. 9 Issue 3,2015

 

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