Facilitated communication (FC), or supported typing, is a scientifically discredited technique that claims to allow non-verbal people, such as those with autism, to communicate. The technique involves a facilitator guiding the disabled person's arm or hand in an attempt to help them type on a keyboard or other such device that they are unable to properly use if unfacilitated.
There is widespread agreement within the scientific community and among disability advocacy organizations that FC is a pseudoscience. Research indicates that the facilitator is the source of the messages obtained through FC, rather than the disabled person. The facilitator may believe they are not the source of the messages due to the ideomotor effect, which is the same effect that guides a Ouija board and dowsing rods. Studies have consistently found that FC is unable to provide the correct response to even simple questions when the facilitator does not know the answers to the questions (e.g., showing the patient but not the facilitator an object). In addition, in numerous cases disabled persons have been assumed by facilitators to be typing a coherent message while the patient's eyes were closed or while they were looking away from or showing no particular interest in the letter board.
James Todd called facilitated communication "the single most scientifically discredited intervention in all of developmental disabilities". Some promoters of the technique have claimed that FC cannot be clearly disproven because a testing environment might cause the subject to lose confidence. However, there is a scientific consensus that facilitated communication is not a valid communication technique, and its use is strongly discouraged by most speech and language disability professional organizations. There have been a large number of false abuse allegations made through facilitated communication.
Overview Facilitated communication is promoted as a means to assist people with severe communication disabilities in pointing to letters on an alphabet board, keyboard, or other device so that they can communicate independently. It has also been called "supported typing", "progressive kinesthetic feedback", and "written output communication enhancement". It is related to the Rapid Prompting Method (RPM), also known as "informative pointing", which also has no evidence of efficacy.
The person with disabilities, who is often unable to rely on speech to communicate, is called the communication partner, while the person holding their arm is called the facilitator. The facilitator holds or touches the communication partner's elbow, wrist, hand, sleeve or other parts of the body while the communication partner points to letters of the alphabet on a keyboard or other device. Biklen describes FC as provision of "physical supports under the forearm, under or above the wrist, or by helping a person to isolate the index finger to facilitate the use of communication aid" and contrasts it with "typing independently, with support by a hand on a shoulder, or hand on a sleeve, leg, or elsewhere".
One device popular with early FC users was the Canon Communicator, which printed a tape of letters when activated. However, two American companies were later charged by the Federal Trade Commission for making "false and unsubstantiated claims" that the device could enable disabled people to communicate using FC. The companies settled and stopped mentioning FC in their advertising campaigns.
Proponents of FC claim that the reason people with autism cannot communicate effectively involves motor issues such as apraxia, and that they "lack confidence in their abilities" but physical support helps them overcome this limitation. However, this claim is unsubstantiated. Research indicates that many non-verbal people with autism spectrum disorder are unable to communicate due to intellectual disability.
The facilitator is depicted as helping the patient with pointing to letters, controlling involuntary arm movements, avoiding mistakes, initiating movement, verbal prompts, and moral support. It is also claimed that the facilitator must believe in the patient's ability to communicate. Former facilitator Janyce Boynton, who came to reject the technique after taking part in blind testing, later reported that her training took for granted that the process worked, and that the complexity of facilitation made it hard to realise that messages were coming from her expectations and not from her patients:
Scott Lilienfeld, the Dobbs Professor of Psychology at Emory University, writing in The Neuroethics Blog, admonishes practitioners of mental health practice not to ignore their "epistemic duties – responsibilities to seek out and possess accurate knowledge about the world", and wrote:
History
Techniques similar to FC appeared around the 1960s, with early observations regarding facilitated teaching of children with autism being published by Else Hansen (Denmark), Lorna Wing (England), and Rosalind Oppenheim (U.S.). Studies were made in Denmark in the 1960s and 1970s, but did not have an impact outside of the country, and the debate there died out in the early 1980s due to a lack of scientific evidence.
In Australia, Special educator Rosemary Crossley independently created facilitated communication in 1977, where it became popular largely due to her efforts. It was popularized in the United States beginning in the late 1980s by Arthur Schawlow and Douglas Biklen. FC has also received attention in Asia and Europe.
Early users of facilitated communication praised it for its apparent simplicity. It was promoted as a "teaching strategy" that did not require objective evaluation or close monitoring. However, as early as 1991, more than 40 peer-reviewed studies had not only failed to demonstrate FC's efficacy, but indicated that any successes reported were due to facilitator influence. This influence is usually attributed to non-conscious movements, and it is thought that facilitators are genuinely unaware that they are controlling the communications.
In 1994, the American Psychological Association (APA), passed a resolution cautioning against the use of facilitated communication, citing the lack of scientific evidence. They also stated that information obtained via FC should not be used to confirm or deny allegations of abuse or to make diagnostic or treatment decisions. In recognition of the continued scientific evidence against the technique, this was followed by similar statements from the American Academy of Child and Adolescent Psychiatry (AACAP), American Speech-Language-Hearing Association (ASHA), and the International Society for Augmentative and Alternative Communication (ISAAC) In 1998, a British government report concluded that "the phenomenon fails to materialise once facilitator effects have been controlled. It would be hard to justify further research on this". By 2001, it was reported in a comprehensive review of peer-reviewed literature that "Facilitated Communication (FC) had largely been empirically discredited as an effective intervention for previously uncommunicative persons with disabilities, especially those with autism and related disorders. Key empirical findings consistently showed that the facilitator and not the client initiated communication."
Many people believed FC had passed its peak, characterizing it as a fad and pseudoscientific. However, promotion of the technique continued, with supporters dismissing empirical investigations as irrelevant, flawed, or unnecessary, and calling FC an "effective and legitimate intervention". As of 2014, the facilitated communication movement remained popular and it continued to be used in many countries. Mostert writes:All the newer pro-FC studies operate from the premise that FC works and is a legitimate practice to be used in investigating any number of other phenomena related to people with autism and other related severe communication problems. Such assumptions increasingly morph FC into a valid intervention among readers who are unaware of the empirical dismissal of the intervention and who might not be skilled in distinguishing solid from suspect research. In this regard, it is likely that FC will continue to reinforce the assumptions of efficacy among parents and practitioners. These perceptions will continue to be reinforced by professional organizations such as the Facilitated Communication Institute at Syracuse University, a fairly wide acceptance of FC internationally, and the vacuum created by few if any future solid empirical studies that are likely to dissuade the faithful.Facilitated communication is closely related to the rapid prompting method (RPM), in which the facilitator holds the letter board instead of touching the patient. Proponents of RPM deny similarities with FC and state that the prompts are "nonspecific". However, RPM contains subtle cuing that makes it highly susceptible to influence from the facilitator.
Other similarities between RPM and FC include: reluctance or refusal to test their claims in controlled settings (purportedly because the process breaks the trust between facilitator and client), presumed competence, reliance on anecdotal accounts as proof of efficacy, maintenance of practices, techniques and claims that are inconsistent with the known research, claims of extraordinary literacy or intellectual breakthroughs, unconscious verbal or physical cuing by facilitators to obtain the expected responses, and inadequate or non-existent protocols to account for the effects of the facilitator.
Rapid Prompting Method has been rebranded as Spelling to Communicate (S2C) and Spellers Method.
In 2019, a dispute about the use of Spelling to Communicate (S2C) developed between the Lower Merion School District and the parent of a child attending school there. The parents claimed the child was deprived of a free education because the district declined to pay for a private educational program based on S2C. In December of that year, the hearing officer in the Pennsylvania Office of Dispute Resolution found that there was no evidence that S2C enabled the child to communicate and thus the school district prevailed.
Organizations supporting and opposing facilitated communication
Supporters In 2010, Autism Spectrum Disorders: A Reference Handbook mentioned the Autism National Committee (AutCom), a parent-led nonprofit, as the main example of an organization that continued promoting facilitated communication, despite research in the mid-1990s which found that facilitators were doing the communicating rather than the children themselves. As of 2022, AutCom continues to state on its website that it "[stands] with autistics, along with their families, friends, and allies, and others who know and respect them, who are working to gain a reliable, autonomous voice", and lists methods it supports including "Facilitated Communication Training (FCT), Rapid Prompting Method (RPM), Spelling to Communicate (S2C), or Informative Pointing Method". Other organizations supporting FC have included the Association for Persons with Severe Handicaps (TASH) and the Autistic Self-Advocacy Network (ASAN).
Opponents Organizations opposing facilitated communication include: The American Academy of Child and Adolescent Psychiatry (AACAP) The American Academy of Pediatrics (AAP) The American Association on Intellectual and Developmental Disabilities (AAIDD), previously called the American Association on Mental Retardation (AAMR) The American Psychiatric Association (APA) The American Psychological Association (APA) The American Speech-Language-Hearing Association (ASHA) The Association for Behavior Analysis International (ABAI) The Association for Science in Autism Treatment The Federal Trade Commission (FTC) Heilpädagogische Forschung The Institute on Disability (IOD) at the University of New Hampshire The University of Northern Iowa