Facilitated Communication (FC) (Should Facilitated Communication still be used? Can it be relied upon?) Nicole Saunders November 22, 2005

What is Facilitated Communication?  Facilitated communication is a procedure in which a facilitator uses some degree of physical assistance to help a client spell out messages by touching letters on a letter display (Biklen, 1990).  A Facilitator normally supports a client's hand, wrist or arm while that person uses a communicator to spell out words, phrases or sentences (Autism Society Canada, 2005).

 An alternative means of expression for people who cannot speak, or whose speech is highly limited and who cannot point reliably. The method has been used as a means to communicate for individuals with severe disabilities, including persons with labels of mental retardation, autism, Down syndrome and other developmental disabilities. (Facilitated Communication Institute)

Where did it all begin?  Australia 1970  Rosemary Crossely started (FC) by encouraging a woman which was diagnosed with cerebral palsy to communicate by acting as her facilitator (National Autistic Society, 2004).  Crossely then went on to establish in 1986: DEAL Communication Centre in Melbourne  DEAL was based on the theory that the language skills of people with autism and other communication disorders were not as impaired as previous notion (National Autistic Society, 2004).

 Late 1980’s  Douglas Biklen introduced to the United States (University of Syracuse)  Biklen obtained a Ph.D. in Social Science from Syracuse University in  Biklen was on a research project in Australia, while he was there he observed Crossely’s work. He returned to the United States where he presented FC to speech therapists and special educators working with nonverbal autistic students.

Biklen’s Research  Once Biklen and some colleagues tried the technique they reported to find unbelievable results. Nonverbal students were communicating to others.  It was said that their reports did not “present accounts of consistent benefit of the technique were unambiguous or standardized measures of communication used for baseline and posttreatment performance assessment.” (Montee et al., 1995)

Controversy Grew while FC use spread  As Biklen and colleagues published their findings, many people became excited. FC brought them feelings of hope to have a chance to communicate with loved ones which was always a hopeless dream before.  Institutions were established and programs to facilitated communication were developed.

Stories  Jeff Powell a student at Baker high school in Syracuse  ("Autism held me hostage for seventeen years but not any more because now I can talk.")  ["I cry a lot about my disability... It makes me feel bad when I can't do my work by myself." Andrew, age 6]  [Please heed my need. I need to heed others. I this reason think the world they need heed like we heed brothers." Manny, 2nd grade] (Palfreman, 1993)

Facilitated Communication a hoax?  As time went by more and more studies were disproving the positive belief of FC.  Many studies were showing that the facilitator was actually the one typing the message.  Ethical issues are also a concern.

For Example: Wheeler, Jacobson, Paglieri, and Schwartz (1993)  Pictures manipulated by using a T-screen apparatus (showed different pictures to the student and the facilitator  Showed:  (a) the client-facilitator pair typed the name of the picture correctly only when the facilitator was shown the same picture  (b) the pair never typed the name of the picture correctly when the facilitator was not shown the same picture  (c) when the facilitator was shown a picture that was not the same as the picture shown to the client, the pair typed the name of the picture shown to the facilitator.

Other studies that demonstrated the same thing  Hudson, Melita, & Arnold, 1993  Moore, Donovan, & Hudson, 1993  Moore, Donovan, Hudson, Dykstra, & Lawrence, 1993  Regal, Rooney, & Wandas, 1994 (Montee et al., 1995) “Research has consistently shown that it is the facilitators (not the clients) who determine the content of the typed message (though unconsciously).” as outlined by Condillac and Perry, (2003)

Ethical Issues presented (Dayan & Minnes, 1995)  RESPECT FOR THE DIGNITY OF PERSONS  A) Informed Consent- Facilitator consent rather then the students consent. b) Confidentiality- third party

 2. Responsible caring- evaluate potential risks and benefits of a treatment and to do no harm. a) IQ testing- may mislead results and create higher expectations of individual which can lead to depression, lower self esteem etc. Alternative- Raven's Progressive Matrices and the Leiter International Performance Scale (Do not require verbal responses.) b) Chance of Mis-use and Mis-interpretation Ex. Cases of reported child abuse.

Reaction?  In the beginning the participants of FC did not pay any attention to the disproving results. Their own personal experiences with their loved ones communicating to them provided a wall in which they could ignore the accusations of FC. No one wanted to believe that their loved ones in truth could not communicate.

Biklen’s Reactions  “Biklen (1993b) claims that (a) experimental arrangements cause clients to become anxious or resistant in facilitated communication sessions, thus impairing their performance; (b) testing destroys the rapport and trusting relationship between the client and facilitator, which also impairs performance; (c) facilitators were not adequately trained in experimental studies; (d) clients had not been in facilitated communication training long enough to be tested; and (e) the autistic subjects in experimental studies had word-finding difficulties (aphasia) and, therefore, that naming pictures or activities is not a valid way to evaluate facilitated communication.” (Montee et al., 1995)

Research to compensate for Biklen’s concerns  (Montee et al., 1995)  7 pairs (client-facilitator)  Normal setting  activities, 24 pictures presented to each client  Three conditions: 1.The facilitator and client had access to the same information 2.The facilitator did not have access to the picture or activity 3.The facilitator was given false information about the picture or activity.

Results  Activity  80% of the time in the false condition trials (unknown to the facilitator), the client answered (typed) the correct answer of the facilitator.  When the facilitator knew what was presented to the student, the students answered correctly 87%

Results continued  Picture  When the facilitator knew what was presented to the student, the student answered correctly 75% of the time.  66% of the trails when the student was presented with a different picture then the facilitator, the student answered correctly for the facilitators picture

 Biklen published Facilitated Communication Digest which included outlines for the use of FC.  Perhaps the technique is useful however, the faultiness is within the teaching of how to correctly use FC.  Biklen, (1993c) also states that controlled studies by Calculator & Singer, 1992; Vazquez, 1994; Weiss, Wagner & Bauman, in press all prove FC works properly

 Accusations of sexual abuse slowly began to change individuals perception and belief’s about FC.

Today  Institutions still promoting and teaching FC Ex. Syracruse University, Indiana Institute on Disability and Community

 Autism Society Canada  “Experts report that FC as a stand-alone program approach is ineffective and potentially harmful for individuals with ASD.” (Autism Society Canada, 2005)  American Psychological Association  “THEREFORE, BE IT RESOLVED that APA adopts the position that facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy.” (APA online, 1994)

Graduate Studies  Patricia Minnes, (Developmental disabilities) Ph.D. in Developmental Psychology - Queen’s University

References  APA online: American Psychological Association: Council Policy Manual : Scientific Affairs.,  Autism Society Canada: Communication systems., s/index_e.html s/index_e.html  Biklen, D. (1990). Communication unbound: Autism and praxis.Harvard Educational Review, 60,  Biklen, D. (1993c). Questions and answers about facilitated communication.Facilitated Communication Digest, 2,  Condillac, R. & Perry, A. (2003). Evidence Practices for Children and Adolescence with Autism Spectrum Disorder: Review of literature and practice guide.  Dayan, J., Minnes, P. (1995). Canadian Psychology. Ethical issues related to the use of facilitated communication techniques with persons with autism

 Montee, B.B., Miltenberger, R.G., & Wittrock, D. (1995) Journal of Applied Behavior Analysis. An experimental analysis of facilitated communication, 28,  National Autistic Society: Facilitated Communication.,  Palfreman, Jon. PBS Frontline: Prisoners of Silence., October 19,  Syracuse University: Introducing teaching and leadership  University of Syracuse, Facilitated Communication Institute: Facilitated communication  Wheeler, D. L., Jacobson, J. W., Paglieri, R. A., & Schwartz, A. A. (1993). An experimental assessment of facilitated communication.Mental Retardation, 31, 49-60

Discussion:  What do you think…  1. Facilitated communication began to be used before any significant testing of validity was conducted.  2. Even after all of the negative evidence provided in study after study, FC is still practiced and taught today.