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Facilitated Communication

Introduction

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Topics in this essay:

	What is Facilitated Communication
	What is an essay on FC doing on this site?
	History of FC
	The FC Controversy

What is Facilitated Communication (FC & FCT)?

FC is a communications technique which some people believe enables individuals with severe communication deficits to communicate. This problem is sometimes caused by "cerebral palsy, head injury, ...Down syndrome...intellectual disability or autism." ₁ It is usually referred to as Facilitated Communication Training (FCT) in Australia, and Facilitated Communication, Assisted Communication," or "Supported Typing" in North America.

It had been practiced by a few isolated individuals for many decades. It first became an organized movement in Australia as a method of helping children with cerebral palsy to communicate. ₂ M.D.Smith and R.G. Belcher, defined it as:

"... a method of facilitating expressive communication...by supporting the communicator's hand, wrist, elbow, or shoulder, and providing backward resistance to assist the individual in selecting letters on a letter board, typewriter, computer using a word processing program, or a small, portable computer" ₃

T. Attwood proposed a somewhat broader definition:

"Facilitated communication is a strategy for improving motor skills to enable someone to point to or touch objects, pictures or letters for communication purposes." ₄

₁₅
Scene from a PBS Frontline TV program showing a client
looking away from the keyboard while she continues to type.

Like so many new movements in the mental health/psychology field, FC was extremely controversial. Most people who have studied FC seem to take one of two polarized positions:

	"believers" who trust FC as a reliable method of communication with some individuals who otherwise would have no method of communicating. It gives previously uncommunicative individuals the opportunity to express their thoughts and feelings. It often shows that people with autism have normal or superior intelligence.
	"skeptics" who believe that FC is an almost totally useless technique -- a cruel hoax. There is a lot of communication in facilitated communication. Unfortunately, it is all coming from the facilitator, and none from the client.

The middle ground is almost unoccupied. Andy Grayson and Cathy Grant have commented:

"In an area which is dominated by extreme positions it is difficult for those who occupy a disinterested midfield position to make themselves heard. But invariably in these matters it is the middle ground which yields the most helpful and constructive answers, by means of carefully designed systematic research which operates over a period of years." ₅

As of 2001, FC was widely promoted in some locations. Its use is actively discouraged or even banned elsewhere. There are relatively few supporters of FC left today. Numerous professional organizations are critical of its usefullness.

Speech-Language & Audiology Canada (SAC) has reviewed FC and Rapid Prompting Method (RPM) -- a similar technique --- and issued a negative recommendation on 2018-JAN-16:

"There is a lack of substantive research evidence demonstrating that FC and RPM are valid forms of augmentative or alternative communication. ... Research studies
show that facilitators consciously and/or unconsciously influence the message being communicated, ... thereby exposing people with communication disorders to risk of harm by preventing genuine self-expression. ... For these reasons, SAC members and associates should not use FC and RPM in clinical practice." ₁₄

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What is an Essay on FC Doing on a Religious Web Site?

We feel that there is a major ethical component to the debate over FC. And ethics is often considered to be a part of one's religion and spirituality.

If FC is proven to be a reliable technique for some people, then the current situation is unacceptable. FC is being banned and discouraged in many areas. To prevent access by disabled persons to an effective method of communication is analogous to locking an innocent person into solitary confinement and throwing away the key.

If FC is a hoax, then the current situation is also unacceptable. If the messages come totally from the facilitator and not from the client, then the autistic person is not really being heard. Time is taken away from other activities that might benefit the individual. It raises false hopes in parents and other caregivers of autistic individuals. The messages themselves can be dangerous; some have accused apparently innocent persons of sexual abuse and other criminal behavior. It raises false hopes in parents and other caregivers of autistic individuals.

The potential for harm is great.

History of FC:

Rosemary Crossley is generally acknowledged as the person who first developed Facilitated Communication Training into a movement. She worked as a teacher in St. Nicholas Hospital in Melbourne, Victoria, Australia during the early 1970's. She believes that she was able to facilitate meaningful communications with 12 children who suffered from severe cerebral palsy. _6,7 Since then, the use of the technique was expanded to include Canada, several European countries, and the United States. FC was widened to include persons with autism and other communication disorders.

1986: Ms. Crossley obtained government funding to start Dignity through Education and Language (DEAL) Communication Center in Melbourne, Australia. DEAL advocated the use of FCT throughout the state of Victoria, Australia. The use of FCT spread rapidly in the state.

1988: An ad hoc group of Australian "psychologists, speech specialists, educators and administrators," called the Interdisciplinary Working Party on Issues in Severe Communication Impairment, issued a critical article, expressing concern that the facilitators were influencing the communications. _8,9

1989: The Interdisciplinary Working Party report motivated the Australian state of Victoria to create an Intellectual Disability Review Panel (IDRP). Their mandate was to conduct a major, detailed, objective review of FCT. Due to a conflict between DEAL and IDRP about the nature of the study, very few individuals were evaluated. "DEAL preferred a qualitative methodology involving naturalistic observation." ₁₀ So, IDRP had to scale down the study and involve only 6 subjects. Two procedures were administered:

	3 of the clients were asked a question; their facilitators sometimes heard the question, and sometimes heard a different question.
	3 of the clients were given a gift which they were later asked to describe using FCT. The facilitator was not told what the gift was.

The panel's report showed:

	The validity of FC with a few clients.
	That in some cases, answers came from the facilitators and not the clients.
	That the facilitators appeared to be genuinely unaware that they were influencing the communication. ₁₁

Unfortunately, the report is not particularly definitive. Few details about the clients were recorded. In particular, their communication abilities without facilitation were not recorded. Unfortunately, the number of clients was very small.

1989: Douglas Biklen, a sociologist and professor of special education at Syracuse University in Syracuse, NY observed FC at DEAL. He was a leader in the "total inclusion movement," which promoted the placement of all students with disabilities into regular classrooms. Biklen felt that the FC technique might be also useful with autistic youths. He introduced the technique to American speech pathologists and special educators. Many reported spectacular results with autistic individuals who had previously never been able to communicate.

1992-1993: Many positive articles about FC appear in mass-circulation magazines, disability media, and on TV.

1992: Biklen founded the Facilitated Communication Institute (FCI) at Syracuse University, at Syracuse NY. During 2010. it was renamed the Institute on Communication and Inclusion. They also use the term "Supported Typing," and "Assisted Communication." ₁₆

1992: The first court case involving accusations of sexual abuse linked to FC is tried in New York state. ₈

1993: Szempruch & Jacobson tested three individuals in Australia. Results were positive. The results have been widely quoted by FC supporters. Unfortunately, the study was flawed by lack of documentation of the "nonfacilitated literary and communication skills" of the subjects. ₁₂ Other papers published that year showed generally negative results.

1993: The PBS program Frontline criticized FC in an episode titled "Prisoners of Silence" on 1993-OCT-19. This did significant damage to the movement.

1993: Douglas Biklen started a newsletter, the Facilitated Communication Digest

1993-1994: A series of controlled studies is published in peer-reviewed journals; all are negative. They tended to show that the facilitator was responsible for the communications. Other studies continue to show positive results.

1994: By this time, in at least 50 locations, messages produced by FC involved accusations of sexual abuse by adults. Many alleged perpetrators were charged. At least one was convicted. Other cases were reported from Australia and Europe.

The American Psychological Association (APA), the American Academy of Child and Adolescent Psychiatry (AACAP), the American Speech-Language-Hearing Association (ASHA),and the International Society for Augmentative and Alternative Communication (ISAAC) passed a resolution cautioning practitioners against the use of FC, citing lack of scientific evidence. ₁₇

1996: The 1993 Frontline program was broadcast again on DEC-17.

1996: One source stated that the FCI has claimed to have "done three studies which verify the reality and effectiveness of FC, while thirty other studies done elsewhere have concluded just the opposite." ₁₃

2009: Ben Goldacre, writing for The Guardian, gave a summary of earlier studies into FC: He said:

"A lengthy research review on educational interventions in autism commissioned in the UK by the Department for Education and Employment in 1998 found that:

'... almost all scientifically controlled studies [in FC] showed that the facilitator was the author of the communication.'

The review concluded that:

'... it would be hard even to justify further research.'

An academic review in 2001 looked at all the more recent studies, updating two earlier reviews with negative conclusions from 1995, and found that overall, again, the claims made for FC are unsubstantiated.

If you prefer authorities to studies, the National Autistic Society says that five major US professional bodies now formally oppose the use of FC, including the American Academy of Child & Adolescent Psychiatry, the American Speech-Language-Hearing Association, and the American Association on Mental Retardation.

The American Psychological Association issued a position paper on FC in 1994 (the height of its popularity) saying 'studies have repeatedly demonstrated that facilitated communication is not a scientifically valid technique' and calling it 'a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy'."

2018: A search on Google on JUL-17 for "facilitated communication" produced 10 links on their first page. All expressed negative views on FC.

The Institute on Communication and Inclusion at Syracuse University, at Syracuse NY " holds "workshops, monthly skill building sessions, and an annual summer institute" to train people in "Assisted Communication," a.k.a. "Supported Typing." ₁₆

The FC Controversy:

Throughout the history of facilitated communication, there has been a suspicion that the facilitator is often doing the communicating, rather than the person being facilitated. Some factors that complicate a realistic validation of FC are:

Individuals who cannot speak are assumed by many to have low intellectual capacity. Since most intelligence tests are based upon spoken or written language, a person who is unable to speak or write may be automatically classified as severely intellectually disabled. This causes many skeptics to assume that all of the communication comes from the facilitator. In fact, the user could be of normal or superior intelligence, yet simply be unable to communicate.

Parents and caregivers experience great frustration and despair when attempting to communicate with their severely autistic children. Conventional treatments and techniques work very slowly, if at all. Many viewed FC as a simple method to break through to the autistic individual. The pressure to accept FC uncritically is almost irresistible.

Facilitators may feel under intense pressure to make FC work. If they are unsuccessful at showing results, they may feel a loss of self-esteem, and a loss of status among their coworkers. Ultimately, they may fear a loss of employment. These factors contribute to an intense desire to produce results. This might induce some facilitators to guide the hand of the user -- perhaps without realizing it.

Many skeptics dismiss FC out of hand, assuming that the facilitator is responsible for all of the communication, as has been demonstrated with "automatic writing, the use of Ouija boards, and channeling." ₁₂

Some media documentaries on FC have been uncritically accepting of the technique. Others have been largely hatchet jobs, prepared without sensitivity to many of the complexities of FC.

Unfortunately, there is a general rule in nature that whenever one measures a phenomenon, then the phenomenon itself is altered. This seems to be true at the nuclear level, in everyday physics, and particularly in the validating of communication techniques. Most (perhaps all) of the studies that produced negative results overlooked certain factors that may have contributed to the failure:

	The presence of one or more strangers observing a FC session may be enough to subtlety change the mood. This might inhibit communication or change it in unpredictable ways.
	One type of experiment would have, say 5, facilitators working in sequence with a single client. If the messages produced appeared to be consistent, then one might surmise that they came from the client. If the messages varied by facilitator, one might guess that the communications originated from the facilitators. Unfortunately, this would not be a definitive test. FC advocates point out that it may take a long time for a facilitator and a client to bond and build up confidence to the point that they can effectively work together. Some users work very well with some facilitators and not at all with others.
	Another experimental technique has been used to determine the reality of FC. This includes: "Asking the facilitator to leave and then proceeding to show the disabled individual a picture of an animal. Next, the facilitator would return to the room and be asked to help the individual answer the question: "What animal did I just show you?" In all of these cases, the questions were answered incorrectly. However, when asked questions while the facilitator was in the room, the correct response would be made. Shockingly, this technique has also led to a series of false sexual abuse cases in which the facilitator would indicate that the disabled individual revealed that they had been sexually abused." ₁₇ In other cases, a few facilitators sincerely felt that they had developed a close and intimate relationship with a disabled individual that led to sexual activity. Lawsuits have resulted.
	Performing a study in a strange environment (e.g. in a laboratory instead of a school) might inhibit communication.
	Performing a study with strange equipment (e.g. with blindfolds or earphones or a different keyboard) might prevent communication.
	Not allowing the users sufficient time to answer the questions, or not allowing the users two or more tries might reduce the number of positive results.
	The users must focus on the keyboard in order for FC to be effective. Some tests allowed the users to stare at walls and ceilings.

Accusations of sexual abuse, arising during facilitated communication sessions, have massively disrupted some American and Canadian families. In some cases, criminal charges were laid before the accusations were verified. Results have included "financial burden for costs of self-defense... sustained separation of family members and stigmatization, unemployment, and alienation of those who have been accused." ₁₂

Many people have equated FC with false recovered memories which have also resulted in accusations and charges of abuse that never happened.

References:

J.W. Jacobson, et al., "A History of Facilitated Communication: Science, Pseudoscience, and Antiscience," American Psychologist, (1995), Vol. 50, No. 9, Pages 750-765. The paper is available at: http://www.apa.org/journals/jacobson.html
Chris Borthwick, "FACILITATED COMMUNICATION TRAINING: AN ANNOTATED BIBLIOGRAPHY," from the DEAL Communications Centre, Inc. at: http://home.vicnet.net.au/~dealccinc/Fccont.htm
M.D.Smith & R.G. Belcher, Journal of Autism and Developmental Disorders 23 (1993).
T. Attwood, T., "Movement disorders and autism: a rationale for the use of facilitated communication." Communication, 26, Pages 27 to 29 (1992).
Andy Grayson and Cathy Grant, "A Micro-Analysis of Video-Taped 'Facilitated Communication Interactions: Are there behavioural indicators of authorship?", Nottingham Trent University. Available at: http://www.ntu.ac.uk/soc/psych/grayson/fcpap-01.htm
John Wobus "Autism Resources," Facilitated Communication Institute, at: http://web.syr.edu/~jmwobus/autism/
Gina Green, "Facilitated Communication: Mental Miracle or Sleight of Hand?" Skeptic Vol. 2, Nbr. 3, 1994, Pages 68 to 76.
D. Bicklen, "Communications Unbound," Teacher's College Press, New York, NY (1993)
"D.E.A.L. Communication Centre operation: A statement of concern," Interdisciplinary Working Party on Issues in Severe Communications Impairment, Melbourne, Australia. (1988)
J.W. Jacobson, et al., "A History of Facilitated Communication: Science, Pseudoscience, and Antiscience," American Psychologist, (1995), Vol. 50, No. 9, Pages 750-765. The paper is available at: http://www.apa.org/journals/jacobson.html
"Investigation into the reliability and validity of the assisted communication technique," Intellectual Disability Review Panel, Department of Community Services, State of Victoria, Melbourne, Australia (1989)
J.W. Jacobson, et al., "A History of Facilitated Communication: Science, Pseudoscience, and Antiscience," American Psychologist, (1995), Vol. 50, No. 9, Pages 750-765. The paper is available at: http://www.apa.org/journals/jacobson.html
R.T. Carroll, "Facilitated Communication (FC)," at: http://dcn.davis.ca.us/~btcarrol/skeptic/facilcom.html
"Official Statement from Speech-Language & Audiology Canada (SAC), SAC, 2018-JAN-16, at: https://www.sac-oac.ca/
This image was downloaded from the Wikipedia Web site at: https://en.wikipedia.org. It is believed to have come from a TV program "Prisoners of Silence" on 1993-OCT-19. It is subject to copyright by PBS Frontline. We believe that its use here is covered by the fair use laws in the U.S. and elsewhere because it illustrates an educational article about the entity that the logo represents; it is used as the primary means of visual identification of the article topic; it is a low resolution image, and thus not suitable for production of counterfeit goods, and it is not used in such a way that the reader would be confused into believing that the article is written or authorized by the owner of the logo.
"About the Institute on Communication and Inclusion," Syracuse University, 2018, at: http://soe.syr.edu/
"Facilitated communication," Wikipedia, as on 2018-JUN-25, at: https://en.wikipedia.org/