Further negative findings on facilitated communication

Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology

An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.

Clever hands: uncontrolled intelligence in facilitated communication

Five studies examined how people who are answering questions on behalf of another person may use their own knowledge to answer correctly while attributing authorship of their answers to the other. Experiments 1 and 2 found that participants instructed to answer yes/no questions randomly were unable to do so. They were more often correct on easy than hard questions, and extended opportunity and incentive did not reduce this effect. Experiments 3-5 found similar correctness for participants who were asked to answer yes/no questions by sensing either the ostensible keyboard finger movements or unvoiced inclinations of another person who had been admonished not to answer, and who was infact a confederate and was not even given the questions. In this paradigm, the answers were often attributed to the other.

Grammar and lexicon in facilitated communication: a linguistic authorship analysis of a Finnish case

This case study adds a new dimension to the discourse on the authorship issue in facilitated communication. The linguistic structure produced by a young Finnish man with severe cerebral palsy was examined. Data are based on transcripts he produced from 1993 until 1996 after facilitated communication had been introduced to him. In the data analysis, as explicit criteria for his idiosyncrasies, we used patterns typical of children acquiring Finnish as their first language and those found in normal slips of the tongue, acquired aphasia, and specific language impairment. Based on the analysis (i.e. the idiosyncrasy and agrammaticality of word-forms and sentences), we strongly suggest that his output can hardly be a product of any other speaker of Finnish, including that of his facilitators.

Look Who's Pointing Now

This article focuses on three factors related to the use of facilitated communication (FC), all of which constitute possible reasons for caution by speech-language pathologists who are considering this technique for individuals with severe communication impairments. First, problems with the theoretical bases of FC are discussed, especially those attributing the success of this method to its ability to target individuals' underlying difficulties with apraxia, word finding, and social-emotional challenges. A case is made that there is insufficient evidence to support claims that FC overrides such problems. The notion of the method unlocking communication and related skills from otherwise competent individuals is also questioned. Next, the subject of candidacy is discussed. Special attention is called to the absence of criteria for initiating, maintaining, modifying, and terminating this approach. Finally, outcomes of the method are summarized. Discrepancies between qualitative and experimental investigations are summarized, along with some possible explanations for these differences. Suggested parameters for evaluating individuals' uses of FC are discussed, along with the continuing need for speech-language pathologists to make informed decisions concerning the role FC will play in their interventions with individuals who exhibit severe communication impairments.