Facilitated communication

Facilitated communication is a method that purports to help people with speech or expressive problems to point to spell out words and sentences. The goal of the method is to enable the person to independently use an augmentative communication device. Usually, the facilitator holds the client's hand, wrist or arm in his hand prompting the patient to pick out letters on a letterboard or keyboard. The facilitator prompts the client to point to letters and puts slight pressure back on the hand, wrist or arm as the client points toward the communication device.

FC is most often used with persons with developmental disabilities such as autism and Down syndrome, whom FC proponents assume have dyspraxia.

The instructional methods that are assumed to help people to achieve this goal are often referred to by the term "Facilitated Communication Training"(FCT).

The practice is controversial, since double-blind studies have shown that in most cases it is not the patient who is producing the words but the facilitator, who cues the subject, unconsciously or otherwise. FC practitioners say only that the studies indicate validity problems. Still, FC is rarely practiced as part of mainstream therapy today, although it retains adherents in several countries.

History

FC first drew attention in Australia in 1977, when a teacher at St. Nicholas Hospital, Rosemary Crossley, produced communication from 12 children diagnosed with cerebral palsy and intellectual handicaps, and argued that they possessed normal intellectual skills. These findings were disputed by the hospital and the Health Commission of Victoria; however, in 1979 one of Crossley's students, Anne McDonald, left the hospital after successfully fighting an action for Habeas Corpus in the Supreme Court of Victoria. After continuing controversy the Victorian Government closed the hospital in 1984-5 and rehoused all the residents in the community. Rosemary Crossley wrote a book about the experience called "Annie's Coming Out" in 1982.

Facilitated communication gained more credibility when Arthur Schawlows, a Nobel prize winning physicist, used it with his autistic son in the early 1980s. His son was later able to do it with little support, just a hand on his shoulder. His experience and its effects on the disability community are described on the Stanford University website [1] (http://news-service.stanford.edu/news/1999/may5/schawlowobit-55-a.html): "They became champions of the technique and were largely responsible for introducing it to the United States, where it remains controversial."

In 1989 Douglas Biklen, a sociologist and professor of special education at Syracuse University, investigated Rosemary Crossley's work in Australia. She was then Director of DEAL (Deal Communication Centre (http://home.vicnet.net.au/~dealcc/facil.htm)), Australia's first federally-funded centre for augmentative communication.

Biklen helped popularize the method in the USA and created the Facilitated Communication Institute at Syracuse University [2] (http://soeweb.syr.edu/thefci/). The method spread across the USA, especially due to its seeming success with autistics, a severe developmental disability accompanied by difficulties with communication.

After starting to use the method in Syracuse, Biklen reported startling results in which students with severe autism were producing entire paragraphs of clarity and intellect. This produced an explosion of popularity. Facilitated communication was strongly embraced by many parents of disabled children, who hoped that their children were capable of more than had been thought.

Concerns

Nevertheless, serious questions regarding FC soon began to surface. For example, some autistic children using FC appeared not to be looking at the keyboard while typing. Still others used vocabulary that was clearly beyond their years. Moreover, some of the communications emanating from FC accused the parents of autistic children of severe sexual and/or physical abuse, although few of these abuse allegations were ever corroborated. Another disturbing fact were the reports about facilitated persons that apparently were able to mindread the thoughts of their facilitators [3] (http://www.omygad.com/YechielSitzman/) [4] (http://www.findarticles.com/p/articles/mi_m2843/is_n5_v22/ai_21076519)

Shortly afterwards double-blind studies were done on the method, demonstrating that in most cases it was the facilitator who was unconsciously producing the communication. In the remaining cases the level of communication was no higher with a facilitator than without one. (review of studies until 1995 (http://www.apa.org/journals/jacobson.html) review of studies until 2001 (http://www.kluweronline.com/article.asp?PIPS=302727&PDF=1)). The practitioners were unintentionally cueing the facilitated person which letter to hit, so the resulting letter strings did not represent the thoughts of the students but the expectations of the facilitators.

As Harvard University psychologist Daniel Wegner has argued, facilitated communication is a striking example of the ideomotor effect [5] (http://www.quackwatch.org/01QuackeryRelatedTopics/ideomotor.html), the well-known phenomenon whereby individuals' expectations exert unconscious influence over their motor actions Daniel Wegner (http://www.wjh.harvard.edu/~wegner/pdfs/Wegner%20Fuller%20&%20Sparrow.pdf). By the late 1990s, FC had been thoroughly discredited in the scientific community [6] (http://www.asatonline.org/about_autism/autism_info09.html).

Other theorists (Maurer and Donnellan) argue that autism is a movement disorder and that there's a synchronistic "dance" to communication in all mammalian social interaction which accounts for the anomalies in validation studies (http://www.autcom.org/rethinking.html).

That was the end of the story for FC in most educational and treatment centers in the USA until the past few years, when FC mounted a comeback in some clinical settings. It was inspired by a 60 Minutes II program in the spring 2003 about people with autism who are assumed to have learned to type independently through the use of FC. Scientists at the MIND Institute studied those autistics and were interviewed for the program. They concluded that it is likely that most classically diagnosed autistics are misdiagnosed as being retarded, and in fact are most likely are very intelligent.

External links

• General:
  • QIM Tunes (http://www.geocities.com/qim/qim_tunes.html) (Book)
  • Samuel Gridley Howe Library Bibliographies: Facilitated Communication (http://www.brandeis.edu/lemberg/SGHL/Subpages/Collections/bibs/Facilit.pdf) (PDF)
  • Historical issues in intervention research: hidden knowledge and facilitating techniques in Denmark (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9135710) (abstract)
  • Cautions Related to the Clinical Use of Facilitated Communication (http://www.asha.org/NR/rdonlyres/9065242C-5CFF-4313-BD85-F7FAF1AC414E/0/11084_1.pdf) (PDF)
  • Report of the MADSEC Autism Task Force (http://www.madsec.org/docs/ATFReport.pdf), pages 35-41 (PDF)
  • Facilitated Communication and Autism (http://www.csaac.org/pub-fac.htm)
  • Issues raised by facilitated communication for theorizing and research on autism (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7605401) (abstract and links to comments)
  • Exchange of Opinion on the Risks and Benefits of FC (http://soeweb.syr.edu/thefci/mrrev.htm)
• Empirical evaluations:
  • Abstracts:
    • Szempruch & Jacobson (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8210603) (1993)
    • Eberlin et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8226584) (1993)
    • Eberlin et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7830210) (1994)
    • Smith et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8050988) (1994)
    • Regal et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8050987) (1994)
    • Simon et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7814312) (1994)
    • Simon et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7814312&dopt=Abstract) (1994)
    • Heckler (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8087605) (1994) (also links to comments)
    • Vazquez (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8720029) (1995)
    • Crews et al. 1995) (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7559286)
    • Weiss et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8828341) (1996)
    • Beck & Pirovano (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8906452) (1996)
    • Howlin (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8838407) (1996)
    • Bomba et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8819770) (1996)
    • Bebko et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8819769) (1996)
    • Kezuka (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9403373) (1997)
    • Edelson et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9586777) (1998)
    • Konstantareas (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9793725) (1998)
    • Perry et al. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Pager&DB=pubmed) (1998)
  • Summaries:
    • Chaptzem.com (http://www.geocities.com/chaptzem/facilcom.html) (2005)
    • Wheeler et al. (http://www.cqc.state.ny.us/hottopics/fcwheel.htm) (1993)
    • Sheehan & Matuozzi (http://soeweb.syr.edu/thefci/2-4shee.htm) (1994)
    • Cardinal et al. (http://soeweb.syr.edu/thefci/cardnew.htm) (1996)
  • Full articles:
    • Montee et al. (http://seab.envmed.rochester.edu/jaba/articles/1995/montee-full.html) (1995)
• Position statements:
  • American Academy of Child & Adolescent Psychiatry (http://www.aacap.org/publications/policy/ps30.htm) (1993)
  • American Psychological Association (http://soeweb.syr.edu/thefci/apafc.htm) (1994)
  • American Speech-Language-Hearing Association (http://soeweb.syr.edu/thefci/3-2ash.htm) (1994)

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