Formally Reviewing Facilitated Communication
Looking at Facilitated Communication
Facilitated Communication (FC) is used for individuals who have difficulty using vocal speech. It has been used for people with Cerebral Palsy, Down’s Syndrome, other health impairments, and autism. The premise is that FC is appropriate for people whom have specific motor issues, but are still able to make use of their arms, hands, and fingers. The individual is then paired with a trained facilitator. This person provides physical and/or other support that allows the person to communicate using a keyboard or pad.
FC had its origins in the 1977 in Australia. Rosemary Crossley, a teacher in a hospital used facilitated communication to elicit communication from 12 students with Cerebral Palsy. Later on this idea (Rosemary’s baby if you will) traveled to the United States and elsewhere.
Douglas Biklen, now the Dean of the College of Education at Syracuse University helped to popularize this idea in the US. He created the Facilitated Communication Institute at Syracuse. The center provided training, consultation, and advocacy for FC. It even produced t-shirts with the slogan "Not being able to speak is not the same as having nothing to say".
The major concern in FC is that the individual being facilitated is not really doing the communicating. It has been argued that FC is just/usually an artifact of the facilitator’s communication. It can be argued that the same ideomotor phenomena we see with Ouija boards and dowsing rods is also in play here.
Another point is the abuse scandals surrounding FC. Skepdic claims that facilitators are taught that 13% of their clients have been abused. In my opinion a surprising number of facilitators have accused parents of abusing the client. Also unsurprisingly, most of these cases turn out to be garbage. And PBS Frontline episode from 1993 chronicles one such case proven to be false. However, the author of FC Wikipedia page reassures us that “numerous abuse allegations made via FC have been found to be valid” and then cites a paper with 4 cases with some degree of evidence out of 13 cases that were reviewed.
Much of the research in FC is qualitative as opposed to quantitative. This means that the research doesn’t attempt to answer whether FC is legitimate, but instead looks to how it affects the quality of life for the user or their family members. Some of the FC supporters also have the habit of forgoing peer review and publishing research in books as opposed to academic journals as seems to be the case for Biklen & Cardinal (1997).
In the quantitative realm, in general, as methodology shows increased control results tend to worsen. Biklen et al. (1995) argue that negative results tend to be associated with higher control, and that positive results tend to originate in naturalistic settings.
An example of positive results found in naturalistic setting would be Simon, Toll, & Whitehair (1994) which involved 7 students were reported prior to the study to be communicating via facilitation at levels far above what was previously thought possible given their level of intellectual ability. The authors found that 1 child out of the 7 could answer correctly on 2 of the trials.
Montee, Miltenberger, & Wittrock (1995) assessed FC for 7 adults in naturalistic conditions. Again, only 1 of the 7 subjects had any correct answers in the unknown or false conditions. The evidence suggested that facilitator control was active in the other conditions. Also, Vasquez (1995) involved a naturalistic setting. Among the 3 autistic children who participated in the study, no valid results were found in the facilitator blinded conditions.
There have been some other positive results such as Cardinal, Hanson, & Wakeham, (1996). The authors used 48 student and 3,800 trials. They randomly selected a word, presented to the student; the student had to type with the aid of their naïve facilitator. Other positive results can be found as well in the literature. Calculator and Singer (1992) have a letter to the editor of Topics in Language Disorders.
The negative results for FC include (Beck & Pirovano, 1996; Eberlin, McConnachie, Ibel, & Volpe, 1993; Regal, Rooney, & Wandas, 1994) as well as the largely negative studies already mentioned (Montee, Miltenberger, & Wittrock, 1995; Simon, Toll, & Whitehair, 1994). In addition, the large study, Howlin (1997) looked at 45 trials of FC involving over 350 participants. The data validated communication by 6% of the participants. The authors showed that over 90% of the cases were influenced by the facilitator. A large review by Mostert (2001) also showed mostly negative results.
Discussion of the Data
The data support the idea that FC may lead to authentic communication in a minority of cases. The data also support the assertion that the majority cases where FC is said to produce communication beyond what was previouly thought, are not authentic. Likewise the data support the criticism that facilitator influence is an active phenomena in the majority of cases in FC.
The data do not support the criticism of the negative findings offered by Biklen et al. that more naturalistic settings tend to produce better results. In fact the available data contradict this (Montee, Miltenberger, & Wittrock, 1995; Vasquez, 1995). No data are available to assess the claim that better results are obtained when the researchers attempt to reassure the participant. There is some data to validate the idea that FC users will improve if given time to practice the testing protocol (Cardinal, Hanson, & Wakeham, 1996). However, this repeated presentation may act over time as a sort of teaching process in and of itself. A group design where individuals are randomly sorted in a short and long testing group, has yet to be done, but is feasible. Such a design could help answer the question.
Champions and Critics
FC has has no lack of famous advocates and detractors. Critics of FC have included Carl Sagan, in “The Demon Haunted World: Science in Candle in the Dark”. The famous skeptic James Randy is a signatory of the anti- FC, BAAM petition. Also, numerous articles critical of FC have appeared in the two skeptical flagship magazines “Skeptic” and the “Skeptical Inquirer”.
On the other side we find Morton Ann Gernsbacher, the past president of the deeply scientific American Psychological Society, and is a sometime publisher in no less a prestigious journal than “Science”. Another noted advocate would be the late Arthur Leonard Schawlow the winner of the 1981 Nobel Prize for his work with laser spectroscopy. He and his wife felt the technique was helpful with their autistic son in the 1980s. I think it would be important to note some of the people who were users of FC have gone on to become adovcates of FC themselves.
Several groups have become advocates of FC. These include TASH and AutCom. Other groups such as The American Psychological Association, The American Association on Mental Retardation, the American Academy of Child & Adolescent Psychiatry, The American Speech-Language-Hearing Association, and the Behavior Analysis Association of Michigan, have offered positon statements agaisnt FC.
Review of the Defence of Facilitated Communication
Here I will look specifically at the claims offered by FC advocates. I will be blunt and say that I think this is weakest area of FC. Below, specific advocates are named and their comments will be scoured for merit.
Dr. Schawlow wrote
“However, most of these studies have given negative results because of serious flaws in their methods, resulting from a failure to understand what was being tested. In fact, all that these studies have shown is that it is possible to interfere with the process of facilitated communication.”
Dr. Schawlow proposes that in a more relaxed setting, positive results will be gained. This is directly in conflict with the data. Moreover, Dr. Schawlow asserts that the negative research proves it is possible to interefere with FC. Here he is assuming that positive results would have been found, had the protocal been different. This is assuming what he should be proving, or the fallacy of begging the question.
Dr. Schawlow wrote
“Clearly, there is an enormous amount of evidence that, under proper conditions, facilitated communication really does work.”
One might ask where is this enormous amount of evidence? Is it peer reviewed? This is where citations can should be given, they are absent in this case.
Dr. Schawlow then rebukes the skeptics by asserting
“It is scandalous that some people are using the unscientific "validation" experiments as an excuse to describe facilitated communication as fraudulent.”
And yet Dr. Schawlow has only ad hoc hyptheses to demonstrate why the controls were actually “fraudulent”. The data that could back his assertions are either absent or actually not in his favor.
Dr. Gernsbacher is the mother of a young man diagnosed with autism. She is a valued and important ally of autistic self-advocates. I will unashamedly profess my respect for her and her work. Her good example has been a model for me as a student. Her article debunking several baloney proofs of an autism epidemic, is an exercise in lucid thought. But she also has offered one opinion on FC that I think is fallacious.
She is reported to have answered a question concerning criticism of FC, by claiming the critics didn’t want to acknowledge the language capability of autistic persons. If this report is an accurate description, then Dr. Gernsbacher employed the psychogenic fallacy. She dismissed the criticism and shifts the focus onto the critics. Those who report this story as a “proof” to challenge criticisms of FC engage in the fallacious appeal to authority.
Finally we come to Biklen
“Despite the controversy over facilitation, thousands of teachers, parents, and researchers continue to use the method nationally and internationally. We might ask why. What do practitioners point to as evidence that convinces them that the words typed are those of the people with disabilities, not of the facilitators?”
Biklen seems to have crossed the border into both a pragmatic fallacy (it look like it works) and an argumentum ad populum.
Biklen in one chapter, quotes a young man who proved in a non pulished replication of an earlier study that his communication is authentic. After proving the authenticity of his writing the young man was inspired to write the following:
“Today I retook the test, and I passed it, Mayer says brilliantly. But I feel sad. Sad for people who can't do it and are silenced. Sad for those who will run from the depressing truth that I was right and they were wrong. Sad that I will be fighting this fight for years to come. And sad that this was even necessary. Friends will celebrate, but then the work must continue.”
If this communication was not authentic, then a fascinating insight into the FC facilitators world view is revealed. But if so, I would argue that the young man severely misses the point of such testing. What does such an attitude tell us about the FC culture, if anything?
The data support the comment that FC may lead to authentic communication for some individuals with autism. The research suggests that these are the minority of cases. The research suggests that facilitator influence is an active factor in FC.
Caution is advised towards FC. I do not advocate the total dismissal of it. However, until safety guidelines are employed, there is reason to doubt the authenticity of communication by those who use it unless there other forms of communication also in use by the individual and at comparable levels.
Cardinal, D, N., Hanson, D, & Wakeham, J. (1996). Investigation of authorship in facilitated communication. Journal of Autism and Developmental Disorders. Mental Retardation. 34(4), 231-42.
Calculator, S.N. & Singer, K.M. (1992). Preliminary Validation of facilitated communication. Topics in Language Disorders (Letter to the editor), 12(6), 9-16.
Biklen, D. & Cardinal, D. N. (1997). Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy. Teachers College Press, New York.
Biklen, D., with Richard Attfield, Larry Bissonnette, Lucy Blackman, Jamie Burke, Alberto Frugone, Tito Rajarshi Mukhopadhyay and Sue Rubin. Autism and the Myth of the Person Alone. New York University Press, (2005)
Beck, A.R. & Pirovano, C.M. 1996. “Facilitated Communicators’ Performance on a Task of Receptive Language.” Journal of Autism and Developmental Disorders, 26 (5), 497–512.
Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. 1993. “Facilitated Communication: A Failure to Replicate the Phenomenon.” Journal of Autism and Developmental Disorders, 23 (3), 507–530.
Howlin, P. Autism: preparing for adulthood. London: Routledge, 1997. pp. 5-6.
Montee, B, B., Miltenberger R, G., & Wittrock D. (1995). An experimental analysis of facilitated communication. Journal of Applied Behavior Analysis. 28, 189-200.
Mostert M.P. Facilitated communication since 1995: a review of published studies. Journal of Autism and Developmental Disorders, 2001, 31(3), pp. 287-313.
Regal, R.A., Rooney, J.R., & Wandas, T. 1994. “Facilitated Communication: An Experimental Approach.” Journal of Autism and Developmental Disorders, 24 (3), 345–355.
Simon, E, W., Toll, D, M., & Whitehair, P, M. (1994). A naturalistic approach to the validation of facilitated communication. Journal of Autism and Developmental Disorders. 24(5), 647-657.
Vazquez, C, A. (1995). Failure to confirm the word-retrieval problem hypothesis in facilitated communication. Journal of Autism and Developmental Disorders. 25(6), 597-610.