Facilitated Communication

Conclusions

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Quotation:
"It is emptiness and hopelessness that make people vulnerable to false prophets, cult leaders . . . who help them become true believers...again, secure in the comfort of new absolutism." M.B. Smith

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Topics in this section:

	Stance taken by various agencies on FC
	What is the reality of FC?
	OCRT Comment

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Stance on FC Taken by Various Agencies:

The following were extracted from various agency home pages and published statements:

American Psychological Association: "...Peer reviewed, scientifically based studies have found that the typed language output (represented through computers, letter boards, etc.) attributed to the clients was directed or systematically determined by the paraprofessional / professional therapists who provided facilitated assistance... Furthermore, it has not been scientifically demonstrated that the therapists are aware of their controlling influence...Consequently, specific activities contribute immediate threats to the individual civil and human rights of the person with autism or severe mental retardation...THEREFORE, BE IT RESOLVED that APA adopts the position that facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy." ₁

The Autism Society of America: "Rather than endorsing one treatment over another,...ASA chooses to let the decision remain in the hands of those who know the individual with autism best. Parents, siblings, the individual with autism himself and other primary caregivers are much more knowledgeable about their child or adult with autism than anyone else." ₂

The Facilitated Communication In Maine: "The purpose of Facilitated Communication In Maine is to promote the appropriate use of facilitated communication through education, technical assistance, and support to people with disabilities, parents, educators, speech and language pathologists support providers, and other interested individuals." ₃

State of New York Office of Mental Retardation and Developmental Disabilities: "... caution in its use is warranted because: (a) research has indicated that apparent benefits of facilitated communication training are infrequently verified; (b) research does not adequately identify the characteristics of the people for whom this training holds substantial promise of enhanced communicative independence; and (c) experience has demonstrated that sensitive communications arise at clinically significant rates in the course of using facilitation." ₄

The Association for Persons with Severe Handicaps (TASH): "Facilitated communication (also referred to as facilitated communication training) is an alternative means of expression that has been used by individuals who cannot speak or whose speech is limited and who cannot point reliably...

THEREFORE, BE IT RESOLVED THAT:

	TASH regards access to alternative means of expression an individual right.
	...TASH encourages careful, reflective use of facilitated communication.
	...TASH encourages use of multiple strategies, including, for example: controlled designs; portfolio analysis; and transitioning to independent typing.
	TASH urges that when allegations of abuse or other sensitive communication occur, facilitators and others seek clarification of the communication and work to ensure that users of facilitation are given the same access to legal and other systems that are available to persons without disabilities. It is important not to silence those who could prove their communication competence while using facilitation or any other method of expression...." ₅

The Vermont Facilitated Communication Network: "The mission of the Vermont Facilitated Communication Network is to support the use of facilitated communication (FC) in Vermont by providing education, training and technical assistance, developing resources, disseminating information, and guiding the development and use of best practices." ₆

The American Academy of Child and Adolescent Psychiatry approved a FC policy statement on 1993-OCT-20 which states, in part: "Studies have repeatedly demonstrated that FC is not a scientifically valid technique for individuals with autism or mental retardation. In particular, information obtained via (FC) should not be used to confirm or deny allegations of abuse or to make diagnostic or treatment decisions." ₇

The American Academy of Pediatrics published a FC policy statement in their 1988-AUG issue of Pediatrics (Vol. 102, Nbr. 2, Pages 431-433). They studied two therapies for autism: auditory integration training and facilitative communication. They concluded that: "Currently available information does not support the claims of proponents that these treatments are efficacious. Their use does not appear warranted at this time, except within research protocols. Concerning FC, they wrote: "As reviewed by Jacobson et al, FC has been the subject of many controlled studies with consistently negative findings, indicating that the technique is neither reliably replicable nor valid." ₈

The American Association on Mental Retardation has apparently issued a negative policy statement on FC. We have requested a copy from the AAMR.

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What is the Reality of Facilitated Communications?

Opinion can be divided among three main groups. Generally speaking, they are not talking to each other:

	Many skeptics believe that FC is a useless technique; it is quackery. It has the potential of generating false accusations of abuse. It consumes time and effort that can better be used applying techniques of value. They consider FC to be simply one more psychological hoax, similar to Satanic Ritual Abuse (SRA), Recovered Memory Therapy (RMT), Multi-Victim / Multi-Offender (MVMO) ritual abuse cases in day care centers, abuse on board UFOs, abuse in former lifetimes, Multiple Personality disorder (MPD), Dissociative Identity Disorder (DID) and treatment of mental illness through Exorcism. FC is useless technique, promoted by caring but deluded parents, caregivers and professionals.
	Many proponents of FC are therapists, speech pathologists, and specialists in special education. They suggest that it can be used with success by many who are communication disabled. R. Crossley & J. Remington-Gurney estimate that 70%. can be helped. ₉ They say that people with autism are do not suffer from “Significantly subaverage general intellectual functioning.” Rather, their problem is "an expressive disorder, being some form of motor planning problem (Crossley, 1993) or apraxia (Biklen, 1990) or dyspraxia (Maurer, 1992) or movement disorder (Hill & Leary, 1992) coupled with aphasia or word-finding problems (Crossley, 1992)." In simpler language, "The theory is that many such individuals do not have cognitive deficits at all, but instead have a presumed neuromotor impairment that prevents them from initiating and controlling vocal expression." ₃They have learned the alphabet and words by watching television and/or by observing their siblings. But they have not been able to speak or write because of their neuromotor deficiencies.
	Many critics of FC are research psychologists. They feel that FC can be meaningfully used only by a few atypical individuals. These are people with a severe communication disability, are able to speak only a few words or not at all, and yet have been able to make use of FC - starting in a fully-guided mode and gradually progressing to full independent typing.

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OCRT Comment:

OCRT stands for the Ontario Consultants on Religious Tolerance, the sponsors of this Web site.

We note that experts in the field have come to diametrically opposed conclusions about FC. These are typically intelligent, caring, dedicated professionals with impressive academic qualifications and decades of practical experience. Yet they have come to totally different sets of beliefs. So we have little reluctance at expressing our own opinions. With the present level of knowledge, we may be as likely to be correct as anyone.

We have tentatively concluded that:

	The skeptical position cannot be defended. There are a very few people who have been diagnosed with autism, who have few or no vocal skills, and yet can use FC effectively. They communicate valid messages with minimal support from a facilitator - perhaps just the touch of a finger on the shoulder. Some are eventually able to eventually type independently.
	The main question regarding FC is not whether it works. The question is what percentage of the autistic population will find it to be a useful technique.
	Autism is a generic label applied to persons who exhibit a group of symptoms. The vast majority are diagnosed correctly as having a severe intellectual deficit. For them, FC is useless as anything other than a game. A small minority are of near normal (or even superior) intelligence but are unable to speak because of a neuromotor impairment. Some of the latter can proceed to independent typing, by using FC as a temporary crutch.
	When FC is first introduced to a person with autism or other communication disability, it is essentially a game. The facilitator determines all of the material that is produced. The vast majority of users remain stuck at this level forever.
	A small minority of users, after gaining experience at FC, are able to contribute some input to the typing. The facilitator is able to withdraw (fade back) support until the user is essentially typing on their own.
	A very small minority are able to progress until they eventually are able to type independently. Some, if given the necessary support, are able to graduate from high school and even enter college or university.
	Some institutions prohibit FC. They prevent their autistic and other communication-challenged clients from even trying the technique. This is of little consequence to most of their clients - those who can never progress beyond using FC as a game. But there exists a small minority that could use it to interact with the world. If FC is banned, then they will be forever trapped in a communication prison due to their lack of ability to speak.

These conclusions would seem to be compatible with all of the evidence turned up during all FC validation studies:

	Much of the communication comes from the facilitator, not the user.
	The facilitators do not seem to be aware that they are influencing much of the typing.
	Users generally fail almost all objective testing.
	A few users are able to demonstrate FC.
	A small minority of users are able to use FC and pursue an advanced education.

Unfortunately, we suspect that few agree with us. Essentially all of those active in FC seem to fall into the skeptic or proponent group. It may take a decade before the truth about FC becomes obvious. Unfortunately, almost all experts are taking extreme positions; few are working towards attaining a consensus. In the meantime, many people are going to suffer from the present impasse:

	many parents and care-givers will have their hopes raised by proponents of FC, only to see them dashed.
	among the small minority of autistic children that can really benefit, some will remain cut-off from FC.

The human toll will remain unacceptably great until a consensus is attained on the effectiveness of FC.

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References:

American Psychological Association, "Resolution on Facilitated Communication," 1994-AUG-14. Reprinted at: http://web.syr.edu/~thefci/apafc.htm
"Facilitated Communication," Autism Society of America, at: http://www.autism-society.org/packages/
Facilitated Communication In Maine is at: http://130.111.120.13/~cci/fcmaine/fcw96b.html
"Guidelines for Facilitated Communication Training," by the State of New York Office of Mental Retardation and Developmental Disabilities is reprinted at: http://www.autism-society.org/packages/fc_guidelines.html
TASH, "Resolution on Facilitated Communication," 1994-DEC. Reprinted at: http://web.syr.edu/~thefci/tashfc.htm
Vermont Facilitated Communication Network is at: http://www.uvm.edu/~uapvt/faccom.html
"Policy statement: Facilitated Communication," at: http://www.aacap.org/publications/policy/ps30.htm
"Auditory Integration Training and Facilitated Communication for Autism (RE9752)," at: http://www.aap.org/policy/re9752.html
R. Crossley & J. Remington-Gurney, "Getting the words out; Facilitated Communication Training," Topics in Language Disorders, (1992) 12, 4, Pages 29-45.