Facilitated communication
Encyclopedia
Facilitated communication (FC) is a process by which a facilitator
Facilitator
A 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...

 supports the hand or arm of a communicatively impaired individual while using a keyboard
Keyboard (computing)
In computing, a keyboard is a typewriter-style keyboard, which uses an arrangement of buttons or keys, to act as mechanical levers or electronic switches...

 or other devices with the aim of helping the individual to develop pointing skills and to communicate. The procedure is controversial, since most peer review
Peer review
Peer review is a process of self-regulation by a profession or a process of evaluation involving qualified individuals within the relevant field. Peer review methods are employed to maintain standards, improve performance and provide credibility...

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. However, some peer-reviewed scientific studies have indicated instances of valid FC, and some FC users have gone on to type "either independently or with minimal, hand-on-shoulder support".

History

Facilitated communication first drew attention in Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

 in 1977, when Rosemary Crossley
Rosemary Crossley
Rosemary Crossley AM is an Australian author and advocate for disability rights and facilitated communication.-Authorship and advocacy:...

, a teacher at St. Nicholas Hospital, claimed to have produced communication from 12 children diagnosed with cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....

 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 McDonald
Anne McDonald
Anne McDonald was an Australian author and an activist for the rights of people with communication disability....

, left the hospital after successfully fighting an action for Habeas Corpus
Habeas corpus
is a writ, or legal action, through which a prisoner can be released from unlawful detention. The remedy can be sought by the prisoner or by another person coming to his aid. Habeas corpus originated in the English legal system, but it is now available in many nations...

 in the Supreme Court of Victoria
Supreme Court of Victoria
The 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 1984-1985 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 University
Stanford University
The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...

 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 Biklen
Douglas Biklen
Douglas 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 University
Syracuse University
Syracuse University is a private research university located in Syracuse, New York, United States. Its roots can be traced back to Genesee Wesleyan Seminary, founded by the Methodist Episcopal Church in 1832, which also later founded 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 communication
Augmentative and alternative communication
Augmentative and alternative communication is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language...

. Biklen helped popularize the method in the USA and created the Facilitated Communication Institute at Syracuse University.

After starting to use the method in Syracuse
Syracuse, New York
Syracuse is a city in and the county seat of Onondaga County, New York, United States, the largest U.S. city with the name "Syracuse", and the fifth most populous city in the state. At the 2010 census, the city population was 145,170, and its metropolitan area had a population of 742,603...

, 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 United States—especially because of 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. In late 1993, a Frontline (PBS) documentary highlighting these concerns was televised, comparing FC to Ouija
Ouija
The Ouija board also known as a spirit/fire key board or talking board, is a flat board marked with the letters of the alphabet, the numbers 0-9, the words "yes", "no", "hello" and "goodbye", and other symbols and words are sometimes also added to help personalize the board...

. Most allegations were not proven true. The New York Commission on Quality of Care and Advocacy for Persons with Disabilities had received 21 allegations of abuse by 1995, and all but 1 were tossed for lack of proof or physical impossibility. A 1995 study of 13 allegations found only proof for 4 of them and couldn't validate or refute the validity of facilitated communication for discovering abuse. FC proponents responded with criticisms of negative bias
Bias
Bias is an inclination to present or hold a partial perspective at the expense of alternatives. Bias can come in many forms.-In judgement and decision making:...

. Sexual abuse accusations via facilitated communication have been consistently rejected as valid evidence in courts of justice, and many autism societies recommend against using FC evidence to confirm or deny these allegations.

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.

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.

TASH
TASH (organization)
TASH 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 Committee
Autism National Committee
The 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, saying that the criticism is based in "flawed studies that are poorly designed and/or whose results are incorrectly extrapolated to the entire population of FC users", saying that FC could be valid for some persons in some circumstances. Autcom also says that, while facilitator influence is real and should be avoided, real user-authored communication can still happen.

Current position statements of certain professional and/or advocacy organizations do not support the use of facilitated communication because of their objections that it lacks scientific validity or reliability. These organizations include the American Speech-Language-Hearing Association
American Speech-Language-Hearing Association
The American Speech–Language–Hearing Association is a professional association for speech–language pathologists, audiologists, and speech, language, and hearing scientists in the United States and internationally...

, American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...

 (AAP), American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

 (APA), Association for Behavior Analysis International (ABAI), American Academy of Child and Adolescent Psychiatry
American Academy of Child and Adolescent Psychiatry
The American Academy of Child and Adolescent Psychiatry is a 501 non-profit professional association in the United States dedicated to facilitating psychiatric care for children and adolescents. Established in 1953, the Academy is headquartered in Washington, D.C...

 (AACAP), American Association on Mental Retardation (AAMR; now the American Association on Intellectual and Developmental Disabilities; AAIDD), Behavior Analysis Association of Michigan (BAAM), and Heilpädagogische Forschung. ABAI calls FC a "discredited technique" and warns that "its use is unwarranted and unethical."

Research

Some neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...

s and psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...

s believe there is a high incidence of dyspraxia
Dyspraxia
Developmental dyspraxia is a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body...

, 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 autism
Autism
Autism is a disorder of neural development 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 affects information processing in the brain by altering how nerve cells and their...

 and moderate and profound mental retardation
Mental retardation
Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...

 may have "undisclosed literacy", or the capacity for other symbolic communication, consistent with higher intellectual functioning than has been presumed.

However, 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
Clever Hans
Clever Hans was an Orlov Trotter horse that was claimed to have been able to perform arithmetic and other intellectual tasks....

" 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 University
Harvard University
Harvard University is a private Ivy League university located in Cambridge, Massachusetts, United States, established in 1636 by the Massachusetts legislature. Harvard is the oldest institution of higher learning in the United States and the first corporation chartered in the country...

 psychologist Daniel Wegner
Daniel Wegner
Daniel 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...

 has argued that facilitated communication is a striking example of the ideomotor effect
Ideomotor effect
The 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. For instance, tears are produced by the body...

, 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 Communication
Augmentative and alternative communication
Augmentative and alternative communication is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language...

 has done theoretical research about facilitated communication. In his opinion "The existing evidence clearly demonstrates that facilitating techniques usually led to automatic writing
Automatic writing
Automatic writing or psychography is writing which the writer states to be produced from a subconscious and/or spiritual source without conscious awareness of the content.-History:...

, 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."

A 1998 research review for the Department for Education and Employment concluded that, apart from some anecdotical and ethnographical reports, all research found the effect disappeared once the facilitators were controlled, and "[i]t would be hard to justify further research on this, given the many areas where there is insufficient, or no, research.".

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 APS
Association for Psychological Science
The Association for Psychological Science , previously the American Psychological Society, is a non-profit international organization whose mission is to promote, protect, and advance the interests of scientifically oriented psychology in research, application, teaching, and the improvement of...

 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 Rubin
Sue Rubin
Sue 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 Blackman
Lucy Blackman
Lucy 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.

Beukelman
David Beukelman
David 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 Communication
Augmentative and alternative communication
Augmentative and alternative communication is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language...

, 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."

Further reading

  • Facilitated Communication Training: An Annotated Bibliography
  • Samuel Gridley Howe Library Bibliographies: Facilitated Communication (PDF)
  • American Academy of Child and Adolescent Psychiatry Policy statement of facilitated communication. AACAP Newsletter, February 1994.
  • American Academy of Pediatrics Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433 (1998)
  • American Association on Mental Retardation (1994). AAMR Board approves policy on facilitated communication. AAMR News & Notes, 7 (1), 1.
  • American Psychological Association Resolution on facilitated communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California.
  • American Speech-Language-Hearing Association Position statement on facilitated communication. ASHA, 37, 22. March, 1995
  • Association for Behavior Analysis Statement on facilitated communication. ABA Newsletter, 18 (2), 1995
  • The Association for Science in Autism Treatment
  • Bauman, M., and editors of The Autism Society Of America (1993). An Interview with Margaret Bauman. Advocate, 24(4), 1 & 13-17
  • Behavior Analysis Association of Michigan Resolution of the Behavior Analysis Association of Michigan on "Facilitated Communication." Adopted at the 1998 Annual Convention
  • Biklen, D., with Richard Attfield, Larry Bissonnette, Lucy Blackman, Jamie Burke, Alberto Frugone, Tito Rajarshi Mukhopadhyay and Sue Rubin. Autism and the Myth of the Person Alone. New York University Press, (2005) ISBN 0-8147-9927-2
  • Biklen, D. & Cardinal, D. N. (1997). Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy. Teachers College Press, New York.
  • Beukelman, D.
    David Beukelman
    David 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, P. Augmentative and Alternative Communication: Management of Severe Communication Disorders in Children and Adults. Paul H. Brookes, (1998) ISBN 1-55766-333-5
  • Blackman, L. Lucy's Story: Autism And Other Adventures. Foreword by Tony Attwood. Jessica Kingsley Publishers, (2001) ISBN 1-84310-042-8
  • 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
  • Crossley, R., and McDonald, A. Annie's Coming Out. Viking Penguin, (1984) ISBN 0-14-005688-2
  • Calculator, S.N. & Singer, K.M. (1992). Preliminary Validation of facilitated communication. Topics in Language Disorders (Letter to the editor), 12(6), ix-xvi.
  • 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 (October), 408–414
  • Cardinal, D. N., Hanson, D., & Wakeham, J. (1996). An investigation of authorship in facilitated communication. Mental Retardation, 34(4), pp231–242.
  • 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
  • Dwyer, Joan. (1996). ACCESS TO JUSTICE FOR PEOPLE WITH SEVERE COMMUNICATION IMPAIRMENT. The Australian Journal of Administrative Law, February 1996, 3(2), 73-119. (online copy)
  • Frugone, Alberto (2005). Independence: What It Is, How To Reach It. Our Voices, March 2005. (online copy)
  • Heilpädagogische Forschung Resolution zur Gestützten Kommunikation. Heilpädagogische Forschung Nr. 1, 2003
  • Intellectual Disability Review Panel. (1989). Report to the director-general on the validity and reliability of assisted communication. Melbourne, Victoria, Australia: Victoria Community Services.
  • 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
  • Mostert, M. (2001) Facilitated communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders, 31(3), 287-313.
  • Sheehan, C. & Matuozzi, R. (1996) Validation of facilitated communication. Mental Retardation, 34 (2), 94-107.
  • Spitz, H. (1997). Nonconscious Movements: From Mystical Messages To Facilitated Communication. Lawrence Erlbaum Associates
  • Twachtman-Cullen, D. (1997). A passion to believe: Autism and the Facilitated Communication Phenomenon. Boulder, Colorado/Cumnor Hill, Oxford: Westview Press
  • von Tetzchner, St. & Martinsen, H. (2000): Introduction to Augmentative and Alternative Communication. Second Edition. London: Whurr
  • Wegner, D. M., Fuller, V. A., & Sparrow, B. (2003). Clever hands: Uncontrolled intelligence in facilitated communication. Journal of Personality and Social Psychology, 85, 5-19.

External links



Position statements against

Position statements in favor
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK