Brief report: evaluation of eight case studies of facilitated communication

How Teachers Confirm the Authorship of Facilitated Communication: A Portfolio Approach

Facilitated communication has been characterized as an alternative to speech that involves providing physical and emotional support to individuals with severe communication impairments as they type or point to letters or pictures (Biklen, 1993). The method has been described as relevant for individuals who cannot speak, whose speech is extremely limited (e.g., echolalic, comprising a few words) and who cannot point independently and reliably (Biklen, Morton, Gold, Berrigan, & Swaminathan, 1992; Crossley 1992). Qualitative and controlled studies of the method demonstrate its usefulness for some individuals and that facilitators may influence the communication of some individuals. This qualitative study of seven speech and language teachers and classroom teachers working with 17 students, focused on how and on what basis the teachers determined for themselves that the words typed were authored by their students and not by them, the facilitators. The teachers provided and described evidence for 13 of the 17 students of message passing skills (i.e., typing information not known to their facilitators that could be verified as accurate). The teachers noted that 3 of these 13 and 4 of the total 17 achieved some independent typing beyond typing their names and the date. Sixteen of the 17 students were judged by their teachers to have confirmed their typing/communication ability by virtue of other features: unique physical characteristics in typing or pointing, personal themes, recurring phrases, and stylistic qualities. These features appeared in their individual work but not in others, even though several shared facilitators. These findings suggest the potential value of a communication portfolio approach to documenting individuals' abilities to communicate with facilitation.

Facilitated Communication

This study examined types of support in Facilitated Communication with 12 non-verbal individuals with autism. Literacy tasks of graduated difficulty that included letter identification, word comprehension, labelling and sentence completion were employed to address the possible presence of literacy under three conditions of support: physical, emotional and mental. Although full facilitator support resulted in high performance levels on all tasks, emotional and physical support alone yielded unintelligible or minimal output. Thus, contrary to proponents' claims as to the importance of physical and emotional support, facilitated output hinges crucially on facilitator-provided mental support. In this study this was true regardless of task difficulty and motor requirement complexity, arguing against the technique's relevance to overcoming motor or emotional problems and demonstrating literacy in individuals with autism.

Facilitated communication and authorship: a systematic review

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

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.

Failure to confirm the word-retrieval problem hypothesis in facilitated communication

Two hypotheses were raised and empirically tested to account for the failure of previous controlled validation studies to find evidence of literacy in nonspeaking persons with autism using facilitated communication: (a) The naming tasks used in other studies have triggered specific "word retrieval" problems, or anomia, and (b) a perceptual problem, visual agnosia, prevents subjects from recognizing objects without touching them. Three nonspeaking autistic children who had used facilitation for at least 2 years were evaluated with four experimentally controlled tasks, over a period of 5 months. In descriptive and object handling tasks, and in a traditional picture identification task, subjects failed to type correct answers when facilitators were blind; one subject, however, occasionally engaged in signing and vocalizations that were context-appropriate. Results reflected a generalized language deficit, rather than isolated word-finding or perceptual difficulties, and were consistent with many previous studies revealing facilitator cuing. Questions are raised about inconsistencies in pseudo-correct scores, a measure of facilitator influence, reported here and in previous research.

An experimental analysis of facilitated communication

We evaluated the authorship of messages produced through facilitated communication by 7 adults with moderate or severe mental retardation and their facilitators. The clients had been reported to be communicating fluently through facilitated communication. We controlled the facilitators' access to information to be communicated in two evaluation formats, naming pictures and describing activities. In both formats we conducted three conditions: (a) the facilitator and client had access to the same information, (b) the facilitator did not have access to the picture or activity, and (c) the facilitator was given false information about the picture or activity. The results showed that the clients typed the correct answer only when the facilitator had access to the same information, never typed the correct answer when the facilitator had no information or false information, and typed the picture or activity presented to the facilitator when it was different from the one experienced by the client. These results provide unequivocal evidence for facilitator control of typing during facilitated communication.

A naturalistic approach to the validation of facilitated communication

By manipulating the facilitator's knowledge of a student's just-completed activity, facilitated communication ability and the extent of guiding were assessed. Seven students diagnosed with mental retardation and their facilitators participated in the study. All 7 students were purported at the start of the study to be communicating via facilitation at levels far above what was previously thought possible given their level of intellectual ability. A large degree of facilitator guiding was revealed for each of the 4 facilitators. Minimal evidence of facilitation was found for 4 of the 7 students. One of the 7 students demonstrated validated facilitated communication on two trials.

Belief in and use of a questionable technique, facilitated communication, for children with autism

23 educators and therapists of children with autism were surveyed about their beliefs and use of Facilitated Communication, a technique previously shown to have questionable scientific validity. 65.2% or 15 use the procedure often or very often in their work with children. Some factors that appeared related to this choice were beliefs consistent with those of proponents of Facilitated Communication, less education, belief in the notion that individuals with autism were more intelligent than their behavior indicated, and lack of belief in science as a source of explanation of human behavior. It was concluded that supervisors need to be more informing about the scientific validity of techniques used by their employees.