Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.

“Say Just One Word at First”: The Emergence of Reliable Speech in a Student Labeled with Autism

This article presents a qualitative, interpretivist research study that documents the emergence, in the context of typed expression, of increasingly useful and reliable speech for a young person labeled with autism. The authors construct a descriptive narrative of the process of this young man's emergent speech development and organize the data around four components of this complex, dynamic, and nonlinear process: (a) echolalia or “unreliable” speech, (b) reading out loud, (c) using reliable speech, and (d) integrating speaking and typing. Additionally, the authors identify three categories of supports that this young man and his family experienced and interpreted as being supportive of his emergent speech. These categories include (a) the importance of taking risks, (b) the importance of seeing and hearing words together, and (c) the importance of an inclusive academic education including rich literacy experiences. Throughout, this inductive analysis constructs an understanding of how this young man and his family have experienced and interpreted his emergence as a reliable speaker.

Changing course

Although the field of behavior analysis provided the formative experiences and much of the profession training that have fueled a long and satisfying career, I now find that I am turning away from behavior-analytic research and teaching. My reasons for making this change stem from concerns about the costs and potential benefits of basic behavior-analytic research strategies and the isolation of behavior analysis from mainstream science. I offer some suggestions for strengthening the profession.

Science and pseudoscience in communication disorders: criteria and applications

PURPOSE

The purpose of this tutorial is to describe 10 criteria that may help clinicians distinguish between scientific and pseudoscientific treatment claims. The criteria are illustrated, first for considering whether to use a newly developed treatment and second for attempting to understand arguments about controversial treatments.

METHOD

Pseudoscience refers to claims that appear to be based on the scientific method but are not. Ten criteria for distinguishing between scientific and pseudoscientific treatment claims are described. These criteria are illustrated by using them to assess a current treatment for stuttering, the SpeechEasy device. The authors read the available literature about the device and developed a consensus set of decisions about the 10 criteria. To minimize any bias, a second set of independent judges evaluated a sample of the same literature. The criteria are also illustrated by using them to assess controversies surrounding 2 treatment approaches: Fast ForWord and facilitated communication.

CONCLUSIONS

Clinicians are increasingly being held responsible for the evidence base that supports their practice. The power of these 10 criteria lies in their ability to help clinicians focus their attention on the credibility of that base and to guide their decisions for recommending or using a treatment.

Facts, interpretations, and explanations: a review of Evelyn Fox Keller's Making sense of life

The job of a researcher is to explain the phenomenon that he or she is seeking to understand. To do this requires the accumulation of facts. These facts are then interpreted to arrive at explanations. However, individual researchers often interpret facts in different ways and arrive at disparate explanations. In her book, Making Sense of Life, Evelyn Fox Keller (2002) outlines various approaches used by developmental biologists to understand the animate systems we call life. In this review, I note several parallels between biology and behavior analysis in how facts are discovered, what is an acceptable interpretation of data, and how explanations are arrived at.

Toward Functional Augmentative and Alternative Communication for Students With Autism

Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?

Hysteria: a delusional state

This paper explores the hypothesis that hysterical symptoms may best be regarded as the product of delusional thinking. Hysteria has generally been interpreted as a process quite distinct from other psychiatric disorders. An attempt is made to bring it within more conventional bounds.

Epidemiology as an essential tool for establishing prevention programs and evaluating their impact and outcome

Emerging trends in health care place speech-language pathologists and audiologists on the threshold of role expansion. To include prevention efforts within this new role, clinicians need to ask about the determinants of communication disorders that are preventable within the general population or within sub-populations. In this article, epidemiology is presented as a tool for the primary prevention of a broad range of factors associated with increased rates of communication disorders. "Old" epidemiologic theory, based on populations, blends with the "new" epidemiologic approach emphasizing the contribution of individual behaviors to adverse health outcomes, to provide the working clinician with a framework from which to determine the direction prevention efforts must take. The PRECEDE-PROCEED model of program planning and evaluation (Green and Kreuter, 1991) is utilized in public health and holds potential for use by clinicians in preventing communication disorders. Application of communication disorders to the PRECEDE-PROCEED model is offered as an example of prevention planning.

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.