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Facilitated Communication and Autism

Does Facilitated Communication Really Work?

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Updated February 05, 2014

Plush Studios/Getty Images
Photo: Plush Studios / Getty Images
According to the Facilited Communication Institute at Syracuse University in New York, facilitated communication training:

    FCT, (hereafter called facilitated communication or FC), is one form of augmentative and alternative communication (AAC) that has been an effective means of expression for some individuals with labels of autism and other developmental disabilities. It entails learning to communicate by typing on a keyboard or pointing at letters, images, or other symbols to represent messages. Facilitated communication involves a combination of physical and emotional support to an individual who has difficulties with speech and with intentional pointing (unassisted typing).
Over the years, FC has received a good deal of attention, and many researchers have looked into its validity. As a result, there are various points of view about FC's real usefulness.

The Case Against FC

In general, mainstream practitioners reject FC, and organizations including the American Speech-Hearing-Language Association, the American Psychological Association and others have specific policies stating that FC is an unproven technique which has the potential to cause more harm than good.

Those people who reject FC claim that the FC facilitator -- who physically supports the arm or hand of the typer -- is, in fact, tapping out his own conscious or unconscious thoughts. Occasionally, those thoughts have included unfounded claims of abuse against parents and caregivers.

To explain the FC phenomenon, some researchers have compared FC to a Ouija board. A ouija board is a board with letters on it. Two people place their fingers on a marker, and spirits of the dead are supposed to guide their hands to letters on the board, spelling out a message from beyond the grave. Very often a message is, in fact, spelled out -- but research has showed that the users themselves are unconsciously moving their hands.

The Case for FC

Those people who support FC as a real tool for communication with nonverbal individuals on the autism spectrum have done their own research. Most of the time, supporting studies have focused on individual case studies. To prove that the typer is, indeed, typing his own thoughts, they asked questions that the supporter could not possibly answer. In some cases, the typer actually typed out answers that made perfect sense.

The Facilitated Communication Institute lists many peer-reviewed case studies like those described above, most dating from the early and mid 1990s when FC was most popular. In addition, a new but similar technique called "Rapid Pointing" has helped raise new interest in the approach. Rapid Pointing is described in detail in Portia Iversen's book Strange Son, and FC can be seen in action in the video Autism: The Musical.

Should We Try FC?

While there are certainly organizations and institutions that will provide FC training (including Syracuse University), FC is not a first choice for communication. Before getting involved with FC, it makes sense to try teaching a child with autism to use better-known, better-understood techniques. Some options include picture cards, American Sign Language, electronic tools such as augmentative speech devices, and, of course, ordinary (unsupported) typing. Not only are these techniques less controversial, but they're all more widely usable and understood.

In the long run, if a nonverbal individual is interested in communicating with the larger community, it makes sense to teach techniques that will allow this individual to communicate independently and fluently. If, however, more typical tools have failed, FC may be a possible direction to try. If you do try FC, be sure to investigate the provider and the therapist thoroughly to ensure you're not the victim of a scam.

Sources:

American Academy of Child and Adolescent Psychiatry. Policy statement of facilitated communication. AACAP Newsletter, February 1994.

American Academy of Pediatrics. Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433.

American Association on Mental Retardation. AAMR Board approves policy on facilitated communication. AAMR News & Notes, 7 (1), 1.

American Psychological Association. Resolution on facilitated communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California.

American Speech-Language-Hearing Association. Position statement on facilitated communication. ASHA, 37, 22.

Association for Behavior Analysis. Statement on facilitated communication. ABA Newsletter, 18 (2). Broderick, A. A. & Kasa-Hendrickson, C. "Say just one word at first”: the emergence of reliable speech in a student labeled with autism. Journal of the Association for Persons with Severe Handicaps, 26, 13-24.

Mostert, M. P. Facilitated communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders, 31, 287-313.

Niemi, J. & Karna-Lin, E. Grammar and lexicon in facilitated communication: A linguistic authorship analysis of a Finnish case. Mental Retardation, 40, 347-357.

Viadero, Debra. Facilitated Communication Under New Scrutiny. Education Week, November 17, 1993.

Weiss, M., Wagner, S., & Bauman, M. A validated case study of facilitated communication. Mental Retardation, 34, 220-230.

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