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Facilitated communication

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Facilitated Communication (FC) is a scientifically debunked[1] technique whereby a paraprofessional called a "facilitator" allegedly helps a formerly non-communicative person to communicate. The best known uses of FC are in cases of autism, intellectual disability, and cerebral palsy. This technique has given great hope to many and grief to some, with few validated results.

The movement in favor of FC seems to have peaked in the 1990s and was severely impacted by a scathing Frontline report on PBS.[2]

Syracuse University maintains an institute, the Institute on Communication and Inclusion,[3] (originally called the Facilitated Communication Institute until 2006[4]) for the teaching and study of FC. Despite the fact that FC is used primarily for disabilities of the mind, the institute is not hosted by the psychology department, which should not be surprising given that the American Psychological Association takes an official stand against FC.[5]

Some of the most common methods of FC are to have a facilitator and patient guide each other's hands to letters on a keyboard or letters and words on a specially designed communication board.

Study of FC[edit]

Evidence regarding facilitated communication is mostly negative, with evidence for it being mostly anecdotal.

Since the facilitator is used to communicate, it's easy to fall into circular logic (FC works because the facilitator told us that FC works). The best way to study the validity of FC is to show or say something to the disabled person when the facilitator is not in the room, and then see if the disabled person can use the facilitator to say what they saw or heard.

Evidence against FC[edit]

Facilitated communication can fail even when the facilitator thinks it's working. Due to the ideomotor effect, the facilitator's natural twitches and movements can direct the disabled person's hand, similar to the use of dowsing and ouija boards.

Publication of controlled studies peaked in the 1990s, with the near universal failure to validate the technique. The only positive studies are either testimonials, or very small poorly controlled experiments, making their validity dubious.[6][7][8][9]

In cases when an individual can type independently, using a facilitator can actually impede them.[10]

Facilitated communication is opposed by many medical organizations, including the International Society for Augmentative and Alternative Communication (ISAAC).[11] ISAAC summary on FC noted that:[11]

  • Support for FC is primarily anecdotal.
  • There are many reports of negative effects of FC, though this is not conclusive.
  • Systematic reviews showed that FC authorship was attributable to the facilitators, not the persons with the disability.
  • Several allegations of sexual abuse were associated with FC.
  • The use of FC may be in violation of several articles of the United Nations Conventions on the Rights of Persons with Disabilities.

Anecdotal support[edit]

See the main article on this topic: Anecdotal evidence

There is no definitive evidence supporting FC as a valid technique. In a few cases, individuals using FC have been able to provide information that the facilitator did not know. However, this does not mean the method should be widely adopted.

  • One 2012 study found that an autistic boy was thinking about what he typed, because he looked longer at letters that he wanted to type, and looked towards the next letter of a word before typing it.[12]
  • A 2002 study analyzed the words typed by a Finnish young man using FC. Researchers carefully analyzed his grammar mistakes, and compared them to typical mistakes of young children, adult speakers, people with acquired aphasia, and more. They concluded that based on his errors, the words were most likely written by him, not by a facilitator.[13]

In some cases, people who started off with facilitated communication were able to move on to typing independently, typing without major physical support (such as typing while someone places a comforting hand on their shoulder),[14][15] or speaking.

Newer research is suggesting that FC may not be completely a hoax, and that it may work with certain people under certain circumstances.[16] Experts are divided on whether this evidence is strong enough to reconsider the use of facilitated communication.[17]

Recommendations for families[edit]

Since experts and evidence are conflicted or negative, and FC involves serious risks, facilitated communication is not recommended. Eye-tracking technology can offer a lower-risk way for a person with a disability to communicate.

Risks[edit]

The risks of misusing FC are serious:[18]

  • Falsely leading people to believe their loved one is talking to them
  • Diverting funds from more reliable techniques
  • Making decisions (clinical, legal, or personal) based on FC communication, without clear proof of authorship

False allegations made using FC[edit]

There have been cases where allegations of abuse have stemmed from reports obtained by FC, only for it to be discovered that the facilitator was making the allegations.[19]

One in particular is the case of "Carla", who was removed from the care of her family several times because of reports of abuse made via FC. In her case and several others, the communication was tested and found to be invalid, showing essentially that the facilitator, rather than the subject, made the allegations, leading to pain for the family and subject, and expense for the state.[20][21] The court system has taken a dim view of FC.[22]

One study examined 13 cases of alleged child sexual abuse in which the claims were made using FC. Evidence of abuse was found in only 4 cases: two in which the children had physical injuries consistent with abuse, one in which the child verbally said they were abused, and one in which the perpetrator confessed.[23]

Other harms done by misuse of FC[edit]

Another case involved a woman sexually abusing a disabled man, claiming that he had given consent through FC. However, he was only "able" to communicate when she was the facilitator (not when other family members did so), and a court case found that he had never in fact expressed love for her or consent to sex.[24]

Similar unproven communication methods[edit]

The following alleged communication methods for non-verbal people are also scientifically unproven (and are allegedly just rebrandings of facilitated communication[25]):

  • Rapid Prompting (aka "Soma Rapid Prompt Method")
  • Supported Typing

Alternatives[edit]

New eye-tracking technologies provide a higher-tech, lower-risk option for disabled people who can neither speak nor reliably use their hands.

References[edit]

  1. Facilitated communication and authorship: a systematic review by R. W. Schlosser et al. (2014) Augment. Altern. Commun. 30(4):359-68. doi:10.3109/07434618.2014.971490.
  2. Prisoners of Silence, directed by Jon Palfreman (October 19, 1993) Frontline (archived from February 5, 2009).
  3. Who We Are Institute on Communication and Inclusion, Syracuse University (archived from July 10, 2019).
  4. Facilitated Communication Institute Syracuse University (archived from February 3, 2016).
  5. http://www.apa.org/about/division/cpmscientific.html#4
  6. Mostert, M P. Facilitated communication since 1995: a review of published studies.Journal of Autism & Developmental Disorders. 31(3):287-313, 2001 Jun.
  7. Wheeler DL, Jacobson JW, Paglieri RA, Schwartz AA.An experimental assessment of facilitated communication. Mental Retardation, 1993 Feb;31(1):49-59.
  8. Michael Eberlin, Gene McConnachie, Stuart Ibel,and Lisa Volpe. Facilitated communication: A failure to replicate the phenomenon. Journal of Autism and Developmental Disorders.Volume 23, Number 3 September, 1993.
  9. Elliott W. Simon, Donna M. Toll and Patricia M. Whitehair. A naturalistic approach to the validation of facilitated communication.Journal of Autism and Developmental Disorders. Volume 24, Number 5 October, 1994
  10. Facilitated Communication and Authorship: A Systematic Review
  11. 11.0 11.1 ISAAC Position Statement on Facilitated Communication Augmentative and Alternative Communication 30(4):357-358. doi:10.3109/07434618.2014.971492.
  12. Hidden communicative competence: case study evidence using eye-tracking and video analysis.
  13. Grammar and lexicon in facilitated communication: a linguistic authorship analysis of a Finnish case.
  14. “Barb Doesn’t Talk” ~ Emma
  15. FC and RPM
  16. The Maturing of Facilitated Communication: A Means Toward Independent Communication
  17. Facilitated Communication: A House Divided
  18. http://www.skeptic.com/eskeptic/06-05-25.html
  19. Not Just the Wendrows: Sex Abuse Cases Dismissed After Facilitated Communication
  20. Gorman B.J. Facilitated communication: rejected in science, accepted in court-a case study and analysis of the use of FC evidence under Frye and Daubert.Behavioral Sciences & the Law. 17(4):517-41, 1999.
  21. SHARON L. HOSTLER, JANET H. ALLAIRE and RICHARD A. CHRISTOPH.Childhood Sexual Abuse Reported by Facilitated Communication. Pediatrics. 1993;91;1190-1192.
  22. Department of Social Services ex. rel. Jenny S. V. Mark S., 593 N.Y.S.2d 142 (N.Y. Family Court, 1993) Although his case does not relate directly to employment, it does relate to the testifying of persons with communication difficulties in court in general under the ADA. In 1993 this New York family court held that a child or children with autism, who allegedly had been sexually abused, would not be permitted to testify in court through the use of facilitated communication because:
    • (a) facilitated communication is not a form of communication that is generally accepted within the scientific community;
    • (b) the use of facilitated communication is not required by the ADA.
    (REF: 1993 MPDLR 17(4), p. 385)
  23. Evaluations of Children Who Have Disclosed Sexual Abuse via Facilitated Communication
  24. The Strange Case of Anna Stubblefield
  25. The Pseudoscientific Phenom — Facilitated Communication — Makes a Comeback