Home Academia & Research The Pseudoscientific Phenom—Facilitated Communication—Makes a Comeback

The Pseudoscientific Phenom—Facilitated Communication—Makes a Comeback

by Jason Travers
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Correction: A previous version of this blog inaccurately suggested faculty in the Communication Sciences and Disorders Department at Syracuse University promoted facilitated communication. The Institute of Communication and Inclusion is housed in the School of Education at Syracuse and is not associated with the Communication Sciences and Disorders Department.

In the early 1990s, professionals who served children with autism and other developmental disabilities were swept up by a breakthrough method known as facilitated communication (FC). The method included a “facilitator” who provided physical support at the finger, hand, wrist and/or arm of a child who was believed to be typing his or her thoughts. The method allegedly “unlocked” these children from the prison of an unresponsive body to reveal average and sometimes superior intelligence, advanced literacy skills and profound insight about their experiences.

Although no validating evidence was available, popular media latched onto the story and FC fervently spread throughout the country. When researchers investigated claims made about FC, they discovered facilitators subconsciously authoring the messages and concluded FC was fake. For the most part, FC was widely dismissed by the professional communities and became a history lesson on the dangers of credulity, pseudoscience and the importance of evidence-based treatment.

However, beliefs about FC’s demise are premature.

Facilitated communication remains at the fringes of special education and related professions. The primary advocacy has come from faculty affiliated with the Institute of Communication and Inclusion at Syracuse University. A confluence of recent events reinvigorated the method, which is increasingly touted as “a form of augmentative and alternative communication.” Despite overwhelming scientific consensus that the client isn’t totally controlling the message, the method recently underwent a strategic rebranding and is now called “supported typing” or “rapid prompting method.”

Several indicators suggest FC is not just poised for a comeback, but that it’s already begun. A number of credible organizations lend FC unwarranted legitimacy, including the University of New Hampshire Institute on Disability/Center Excellence in DisabilityUniversity of Northern Iowa, Massachusetts Department of Elementary and Secondary Education, and Vermont Department of Disabilities.

Supporters in academia publish articles in peer-reviewed journals that portray FC in positive light, albeit without demonstrations of its efficacy. Indeed, the method is regaining popularity and school districts are beginning to adopt it for their students with autism.

Facilitated communication—known for being the quintessential pseudoscientific fad in developmental disabilities—is infamous for the number of unsubstantiated charges of sexual abuse made by users. In late 2014, the Wendrow family, whose story was featured on 20/20, was awarded nearly $7 million for wrongful prosecution after sexual abuse allegations were made via FC. Former Rutgers University Philosophy Department Chair and leading FC proponent Anna Stubblefield, who claimed any criticism about FC constituted hate speech, was recently charged with multiple accounts of aggravated  sexual assault after she allegedly acted as a facilitator to obtain consent for sex from a man with a severe disability and communication impairment. Stubblefield pleaded not guilty and her trial is set for August 2015.

The method also appears to have played a role in the murder of a child with autism. In November 2014, wealthy businesswoman Gigi Jordan was convicted of murdering her 8-year-old son. Jordan’s defense centered on her claim that she committed a mercy killing after her son allegedly requested via FC they both commit suicide.

Professionals responsible for teaching communication skills to children, youth and adults with autism and other developmental disabilities should take stock when examining claims of hidden communication skills, sudden breakthroughs and inspiring anecdotes that are incongruous with generally accepted research. Evidence-based interventions and treatments do exist to support acquisition of communication and other skills for these learners, though progress often is painstakingly slow. FC and its variants remain illegitimate and ultimately usurp the voices of individuals with communication impairments.

If those teaching individuals with autism and other developmental disabilities to communicate adhere to evidence-based approaches, they better serve their clients, prevent harm, and halt the proliferation of pseudoscience in autism.

Editor’s Note: Jason Travers will be speaking at the upcoming Schools Conference in Phoenix, July 10-12.  His presentation, Get the Message? The Communicative Nature of Inappropriate Behavior in Learners With ASD, will also be featured at Convention in October. See the full schedule for Schools, which is co-located with the Health Care & Business Institute.

Jason C. Travers, PhD, is an assistant professor of special education at the University of or Kansas. He earned his PhD at the University of Nevada, Las Vegas, while working as a special educator of students with autism in the nation’s fifth-largest school district. He investigates the racial disparity in the administrative prevalence of autism as well as the efficacy of technology for preventing inappropriate behavior while supporting academic, social and communication skills of students with autism. A board-certified behavior analyst, he teaches graduate courses in applied behavior analysis, evidence-based instructional strategies for learners with autism, and issues in special education. jason.travers@ku.edu

 

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3 comments

chaoticidealism May 22, 2015 - 10:54 am

Here’s the trouble with FC: There’s a whole lot of nasty dirty bathwater, but there’s still a baby in there. Autistic people can really have problems with movement, especially perseveration and transitioning from one movement to another. Autistic people who are non-verbal have been known to become literate, especially if their visual processing is better than auditory. Say you have one of those autistic people with messed-up auditory processing, who shows signs of understanding what written words mean but has such trouble breaking out of repetitive movements that they have trouble simply pointing on their own…

The critical thing, with FC and any other aide-assisted communication, is to be absolutely sure that the communication is coming from the autistic person. It doesn’t matter how you do it, but that facilitator has to be absolutely unaware of the conversation’s content. Maybe you employ a facilitator who doesn’t speak the language that the autistic person understands. Maybe you use a visual screen or noise-canceling headphones. Ideally, you use an assistance animal, a dog or perhaps a monkey; or you move to independent typing/pointing. Doesn’t matter how, just do it. And you’re not preventing fraud here–you’re preventing a person with autism from being shouted down by a well-meaning facilitator who seriously thinks that this ouija-board thing is coming from the autistic person rather than from themselves. The best way to shut someone up is to get someone else to speak for them without their permission, and FC is one of the ways that can happen.

But denying someone a communication method also shuts them up pretty effectively, and some people who are honestly communicating, really do need someone to help them. When that’s the case, we owe it to them to both let them speak and make sure no one else is doing the speaking for them.

Henny Kupferstein June 5, 2015 - 10:33 am

Shame on Jason C. Travers, PhD [jason.travers@ku.edu] who compares RPM (Rapid Prompting Method) to a “pseudoscientific phenom” designed to “usurp the voices of individuals with communication impairments”. Shame on you for your cruel and hateful agenda to marginalize my nonverbal clients who tell me every week through RPM how they feel about their piano lessons. Shame on you for pushing your cruel agenda as a board-certified behavior analyst for “preventing inappropriate behavior” through communication. In an effort to “halt the proliferation of pseudoscience in autism”, YOU SHOULD BE SILENCED! ——–I demand that ASHA remove his psychobabble article

pcdurbinwestby June 5, 2015 - 12:29 pm

It is far better to take the risk that there might be one or two fraudulent people out there than prevent many Autistic and other language-disabled people (whether due to autism, cerebral palsy, damaged vocal cords etc.) from having a chance to finally get to communicate in language-based ways with appropriate communicators, and those do exist. Not everyone is out to take advantage of people. Rather than “protecting” nonspeaking people because you are worried that someone might take advantage of them (a very real concern), by dismissing RPM and FC “once and for all” you may be sentencing numerous people to a lifetime of not being able to use language. Below is my initial experience learning about RPM because of my work as a music educator.

To clarify for Travers and others, Facilitated Communication involves someone touching the person or supporting their arm. Rapid Prompting Method does not involve touching. It is not “repackaged FC.” They are two different things. The only similarity is that a nonspeaking person who is presumed to not be able to use language does, in fact, use language.

Not knowing much about RPM but having heard of it, I tentatively suggested it to the parent of a non-speaking music student, saying that it might be something she could look into. At age 9, he had no language-based communication. After a few months¸ his mother told me they had started learning RPM. At age 9, this child, for the first time in his life, used language successfully by pointing at a letter board (stencil with letters of the alphabet which is held up for the nonspeaking person to point to or touch). The kinds of questions he was asked (an academic lesson, which seems to be a focus of RPM), and pointed out answers to, could not have been “prompted” or influenced. Of course, one must assume that all people are “influenced” by their environments, so that *anyone* is more likely to talk about things their families or co-workers discuss, for example. I don’t believe in telepathy, so have a hard time understanding how this non-observable “influence” is said to happen. I wonder if those who insist that a person is not pointing on their own think that thoughts can travel between people’s brains?

Because I had heard of the FC controversy, when I first met this nonverbal music student, I experimented with seeing if I could get the student to touch any particular key on the piano. I tried touching his shoulder, holding his elbow, trying to MOVE his elbow, holding his forearm, and then his wrist. I could not do it at all. After he started using RPM, I decided if he could point at letters, he could play the keys correctly on the piano. (Prior to this we did not try much because no one knew he could- he was not able to communicate in words, no one knew what he might be thinking, and no one, including me, expected it of him. We had “music explorations” and I played songs for him, which he enjoyed. We did the music exploration format for a number of months before he started RPM.) After he started using the letter board and I saw him being able to point at letters, I realized that if he could intentionally point at and touch letters on the letterboard, he could probably also touch specific keys on the piano.

My early experiment in trying to “influence” him to touch keys was misguided because I was not helping him understand that he had to push the keys, and that keys had names that corresponded to letters. It was really just “my chance to see if FC facilitators really can influence a nonverbal person’s arm by moving their elbow.” A basic understanding of human anatomy would suggest not, but I tried anyway, to see if there was anything to the idea that someone could have that much influence over a finger by supporting or even trying to move an elbow or arm. Travers and others who dismiss assisted communication seem to think that supports can be manipulated to an extent not physically possible.

The difference is that once my music student had RPM sessions, and had some experience knowing that he could point intentionally, he knew what I expected when I explained that I wanted him to start playing the piano keys. I labeled the keys and explained that each key had a letter name and that I wanted him to push the key that I called out, such as “A” or “C.” He was able to purposely play keys that I called out to him, the first time we tried it. This was really exciting, because I am *not* an RPM or other assisted technology facilitator, but a piano teacher with no training in RPM, FC, or speech/communication therapy.

Since that initial experience with my music student I have also attended a workshop where RPM was being taught. I paid very close attention to the movements of the facilitators and the letterboard itself. The only prompting the RPM teacher would do was to 1. Encourage the person to continue if they stopped in the middle of pointing (due to attention issues or motor difficulties, I think). 2. If they were spelling something that was already really obvious (to everyone) like the word “elephant” and they pointed at an incorrect letter that was right next to the one they meant, the teacher would say “try the neighbor”. Since there are up to eight neighboring letters (only three if the letter is in a corner) and the person helping does not say which one, and the student generally points at the correct one after being prompted to be more accurate, the teacher is not giving THAT much correction. The four nonverbal people I saw using RPM at most touched one or two other letters before touching the right one, and they mostly pointed at correct letters throughout the session. Even when the going was slow, the facilitator did not move the board to get the person to touch a particular letter. If the RPM facilitator did not yet know what word the person was trying to spell, the facilitator did not give any prompts as to what to do next.

Because I am fairly skeptical and this was my first time watching the process, I actually lined my eye and hand up with the board and sat very still, so that I could see if the facilitator moved it, even going as far as to place my elbow on the desk so that I myself could not inadvertently move my line of sight! (I hope that if any RPM facilitators read this you will forgive me, but I think I did the right thing because I can now describe it more accurately to others).

Regarding facilitated communication, I will talk about one person I have seen use it. That person was very intentional in their movements, although because the person has CP, they needed someone supporting (not moving) their arm while they pointed. This person took a while to point at the letters, but not in the sense that they were being random, but that it took a very long time to do the pointing, what with trying to control their muscle movements.

ASHA should make efforts to learn more about FC and RPM, learn the differences between the two, and work to develop measurement tools that can accurately document communication that is already taking place, not so much for purposes of “proving” or “disproving,” although I think that might have to come first, but so that language therapists will have a full array of communication tools to help clients be able to communicate fully.

After seeing my nonspeaking music student be able to communicate with his family for the first time, I plan to learn more about RPM so that I can incorporate some of the concepts into lessons with students who have communication disabilities.

-Paula C. Durbin-Westby

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