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The Real Story of Facilitated Communication 

02/4/2016

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By Jessica Bacon, M.S., BCBA Facilitated communication (FC), also known as “supported typing” has been, arguably, one of the most spectacular fads among interventions for autism to date.  It’s dramatic rise and fall over the course of a decade, has been covered by multiple news outlets including NBC News, The New York Times, ABC’s newsmagazine show 20/20, and a national PBS Frontline broadcast, exposing the ineffectiveness and potential harm of the technique (Alexander, 2009; Engber, 2015; Gomstyn, 2012; Palfreman, 1993).   Yet FC remains at the fringes of special education and related services, and is currently endorsed by a small number of academic and professional institutions across the country.  The history of FC is both compelling and heartbreaking, and the method is still in use today (University of New Hampshire, Institute on Disability, 2015; University of Northern Iowa, 2015; Massachusetts Department of Elementary and Secondary Education, 2011; Vermont Division of Disability and Aging Services, n.d.; Choi et al, 2006) despite the widespread agreement among the scientific community that it is, in fact, the facilitators who are the source of the message communicated via FC, and not the person with the communication disability (Palfreman, 1993; Wheeler, 1993; Moore, 1993) .    In the early 1990’s, providers and educators, across the country, who served people with autism and other developmental disabilities were instantly influenced by a breakthrough method known as facilitated communication.  This method required an alphabet board, or keyboard, and consisted of a “facilitator” who provided physical support at the finger, hand, wrist and/or arm of a person who was believed to be typing his or her thoughts. A key component of this method seems to have been the belief that persons with autism or other developmental disabilities were of normal, or perhaps of superior intelligence, but their ability to communicate was hindered by physical limitations or motor impairment (Jacobsen et al, 1995; Travers et al, 2014) It is understandable why this belief was so readily adopted by parents and educators, especially when compared to previous beliefs that people with disabilities were of lesser intelligence (Rutter, 1968).   Many believed that FC would be the antidote, not only to the communication disability, but also to discriminating beliefs surrounding people with disabilities (Jacobsen et al 1995; Biklen & Burke, 2006).  What evolved from the method, was a persuasive narrative of children whose inner thoughts were “unlocked” through the help of a “communication facilitator”. Children and adults, who had previously been unable to convey even the simplest of messages, were now conversing with family members, attending college, giving speeches, and co-authoring books (Biklen et al, 1992; Travers, 2014).  People wanted to believe that the method was working.   But there was absolutely no evidence validating FC as an effective method of communication.  In fact, quite the opposite.  The research began to pour in and the results were overwhelming; facilitated communication was not real (APA, 2003; Wheeler et al, 1993; Szempruch & Jacobsen, 1993; Moore, 1993; Jacobsen et al, 1995) .    Studies showed that it was the “facilitator” who was unconsciously creating the messages (Palfreman, 1993; Wheeler, 1993; Moore, 1993). The facilitator’s response, or influence over the communicative partner, is commonly referred to as the “Ouija board” effect; when the body reflexively reacts to ideas or thoughts (Lilienfeld et al, 2015).   These false messages often had severe impact on families.  The number of unsubstantiated charges of abuse made by users of FC was astounding.  A 1994 review (just four years after FC was introduced to the U.S.) reports on five dozen cases of alleged sexual abuse (Margolin, 1994).  Even though most of these cases were thrown out, some children were wrongfully removed from their homes and parents served time in prison.  The traumatic impact on the lives of people with disabilities is hard to imagine.   Recently, FC has again begun to gain popularity, as proponents of the movement have made efforts to “re-brand” the method, claiming it as a valid form of augmentative and alternative communication (Syracuse University School of Education/Institute on Communication and Inclusion, n.d.;, Travers et al, 2014; Lilienfeld et al, 2015).  It is now often referred to as “rapid prompting method” or “supportive typing” (Syracuse University School of Education/Institute on Communication and Inclusion, n.d.; Travers et al, 2014).  The Institute of Facilitated Communication, founded shortly after FC was introduced to the U.S., changed the name of their organization to The Institute on Communication and Inclusion (Syracuse University School of Education/Institute on Communication and Inclusion, n.d.; Enger, 2015).  Large efforts are being made to market FC as a new technique.   Researchers, communication specialists, and responsible professionals are attempting to make it very clear that FC, supportive typing, and the rapid prompting method are not validated forms of augmentative and alternative communication (Travers et al, 2014; Lilienfeld et al, 2014).  FC methods have caused harm to many individuals; preventing them from accessing evidence-based treatments and appropriate intervention, resulting in unconfirmed allegations of abuse, and instilling false hopes among parents, caregivers and educators (Lilienfeld, 2015).  Consumers are urged to stop FC from advancing further and to support organizations that promote evidence based treatment for individuals with disabilities.    References Alexander, B. (2009, December 12). Dark shadows loom over facilitated talk. NBC News. Retrieved from http://www.nbcnews.com/id/34212528/ns/health-mental_health/#.UxJBUFQo6cw      American Psychological Association (2003).  Facilitated Communication: Sifting the Psychological Wheat from the Chaff.  Retrieved from http://www.apa.org/research/action/facilitated.aspx. Celiberti, D. (n.d.) Facilitate This: Part I of a Two-Part Interview with Dr. James Todd. Association of Science for Autism Treatment. Retrieved from http://www.asatonline.org/research-treatment/interviews/facilitate-this-part-i-of-a-two-part-interview-with-dr-james-todd/. Choi, A., Green, Vanessa A.G., Keenan A. P., O’Reilly, M., Sigafoos, J.,(2006). Internet survey of treatments used by parents of children with autism.  Research in Developmental Disabilities, 27: 70-84. Engber, D. (2015). The Strange Case of Anna Stubblefield. New York Times.  Retrieved from http://www.nytimes.com/2015/10/25/magazine/the-strangecase-of-anna-stubblefield.html?_r=0. Gomstyn, A. (2012). Not Just the Wendrows: Sex Abuse Cases Dismissed After Facilitated Communication. ABC News. http://abcnews.go.com/Health/wendrows-sex-abuse-cases-dismissed-facilitated-communication/story?id=15274276   Jacobson, J.W., Mulick, J.A. & Schwartz, Allen A. (1995). A history of facilitated communication. American Psychological Association Inc., 50 (9) 760-765.              Lilienfeld, S.O., Howard, C.S., Marshall, J. & Todd, J.T. (2015). 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.      Margolin, K. N. (1994). How shall facilitated communication be judged? Facilitated communication and the legal system. Facilitated Communication: The Clinical and Social Phenomenon (pp. 227–257). San Diego, CA: Singular Publishing. Massachusetts Department of Elementary and Secondary Education (2011) Guidelines for the  Preparation of Teachers of Moderate and Severe Disabilities: Instruction on the appropriate use of augmentative and alternative communication and other assistive technologies.   Retrieved January 24 2016 from http://www.doe.mass.edu/edprep/advisories/AT-AACguidelines.pdf. Moore, S., Donovan, B., & Hudson, A. (1993). Facilitator-suggested conversational evaluation of facilitated communication. Journal of Autism and Developmental Disorders 23, 541-551. Mostert, M. P. (2001). Facilitated Communication since 1995: A review of published studies. Journal of Autism andDevelopmental Disorders, 31, 287-313.          Palfreman, J. (Producer). (1993, October 19). Frontline: Prisoners of silence. Boston, MA: WGBH Public Television. Syracuse University School of Education/Institute on Communication and Inclusion (n.d) About the Institute of Communication and Inclusion. Retrieved January 24th, 2016 from http://soe.syr.edu/centers_institutes/institute_communication_inclusion/about_the_ici/default.aspx Syracuse University School of Education/Institute on Communication and Inclusion (n.d) What is Supported Typing. Retrieved January 24th, 2016 from http://soe.syr.edu/centers_institutes/institute_communication_inclusion/about_the_ici/default.aspx Szempruch, J., & Jacobson, J.W. (1993). Evaluating the facilitated communications of people with developmental disabilities.Research in Developmental Disabilities 14, 253-264. Travers, T. C., Tincani, M., & Lang, R. (2014).  Facilitated communication denies people with disabilities their voice. Research and Practice for Persons With Severe Disabilities, 39 (3), 195-202. University of New Hampshire/Institute on Disability (2015) Introductory training for Supportive Typing. Flyer retrieved January 28th 2016 from http://www.iod.unh.edu/pdf/2016%20-%20Intro%20to%20ST%20Flyer.pdf. University of Northern Iowa (2015) International Conference on Disability Studies in Education Call for Proposals.  Retrieved January 24th 2016 from  http://www.iod.unh.edu/pdf/2016%20-%20Intro%20to%20ST%20Flyer.pdf Vermont Division of Disability and Aging Services (n.d.)  Vermont Communication and Task Force Information and Resources.  Retrieved January 20, 2016 from http://ddas.vermont.gov/ddas-boards/boards-dds/boards-dds-vctf/. Wheeler, D. L., Jacobson, J. W., Paglieri, R. A., & Schwartz, A. A. (1993). An experimental assessment of facilitated communication. Mental Retardation, 31, 49–59.