A recent development in Finnish services for autistic people has been the uptake of Facilitated Communication as a primary means of eliciting information from non-verbal autistic people that will be used in making diagnostic and treatment decisions regarding the person whose communication is being facilitated. In this method, the client is supported by physical contact at the hand/wrist, or the arm or the shoulder. This contact enables, so the proponents say, the autistic person to overcome the psycho-motor inertia that is (according to the proponents of this method) the cause of autism. As a person on the autism spectrum myself, I am sure that most people would think that I would be solidly behind this method. But I am in fact solidly against it.
Many studies have been done on this method, focussing on the issue of authorship: the problem of determining who actually came up with what has been written. There are also many studies that belie the notion held be the people who promote the method that autistic communication difficulties arise from a psycho-motor inertia problem. In this article, I shall attempt to deal with these two issues in a relatively easy-to-understand way.
The first issue that I mentioned here is authorship: who is actually coming up with what gets said in Facilitated Communication sessions? And how can you tell for sure who it is?
One of the first proper studies into this matter was conducted by staff at the O. D. Heck Developmental Center in Schenectady, New York. The staff were sure amongst themselves that their adoption of Facilitated Communication was helping their clients to express themselves. They had been trained by the people at Syracuse University, under Douglas Biklen (a major proponent of the method). In the study, which lasted three months, hundreds of trials were conducted with twelve students and nine facilitators. The results were presented at a staff meeting, and these results were astounding.
What did these results tell about Facilitated Communication that was so astounding? Did they support the idea that Facilitated Communication was a good method for use with autistic or other communication-handicapped people?
No. They did not.
This study, now known to be the first objective study of Facilitated Communication ever conducted, demonstrated that the typed output under facilitation was not the work of the clients/students but, rather, was the output of the facilitators themselves. How did they know this?
The study involved an experiment, with the participants being “the most competent producers of facilitated communication in the program(me)”. These participants were shown pictures of familiar objects and asked to name them by typing the name of the object. To control for as many confounding issues as possible, the experimenters used three conditions in the experiment. One was that the facilitators did not know the content of the stimulus picture. The second was that there was no facilitator present to assist with typing. The third was that both client/student and facilitator were shown pictures at the same time but, in this condition, the pictures shown would be the same for both partners in the facilitation session some of the time and different some of the time. In the first and second conditions, there was no sensible output from the clients/students; and, in the third condition, the only correct answers given were typed when the facilitator and client/student saw the same picture.
The team at O. D. Heck D. C. concluded that the facilitators were unwittingly influencing the typed output of the clients/students. But is this possible? Can people influence the typed output of a client/student without even realising it? The answer is, in fact, yes.
A social psychologist at the University of Virginia, Daniel Wegner, proposed a way in with this might happen. According to the theory of ironic processes, the very imperative to not act on thoughts can lead to the person actually acting – entirely unconsciously – on those thoughts. It is known that the training of facilitators includes instructions that urge the facilitator to refrain from acting on thoughts they might have about what the client is trying to type. Under this theory, such an exhortation is in fact a means of setting up the facilitator to fall prey to the effects of ironic processes.
Other experimental studies have demonstrated similar results to those obtained by the O. D. Heck D. C. staff. And the effects of ironic processes, as described by Daniel Wegner, seem to be at the heart of why Facilitated Communication seems to work, but actually doesn’t.
Regarding the basis of autistic communication difficulties being a psycho-motor inertia, similar to that seen in some people diagnosed with cerebral palsy, it has to be said that such a theory flies in the face of the best scientific research conducted into autism over the past fifty years. The difficulties experienced by autistic people are indeed mediated biologically, but not in the psycho-motor domain. These problems arise, rather, in the cognitive domain… the domain of thought, language use, memory formation, working memory use, and understanding of social linguistic conventions. The autistic brain develops differently from the so-called typical person’s brain’s development. Because of differences in development, many autistic people do not join in with many others socially: so an idiosyncratic use of language can arise from this phenomenon. There is a demonstrated propensity for autistic people to be slower than typical people at integrating sensory input from different sources. And, whilst there is indeed research that confirms the existence of motor problems in many autistic people, none of this research demonstrates the effects claimed by the proponents of Facilitated Communication as being the basis for the communication difficulties we see in autism.
So, when I see the hoo-haa about Facilitated Communication, and the promise of being able to unlock “hidden literacy” skills and of “giving voice” to the disabled person by means of this method, I find myself reacting in two ways: one cognitive and one visceral. The cognitive response is that I cannot support a belief in Facilitated Communication as producing output that is in fact authored by the client. The visceral response is that I feel sick.
The claims that Facilitated Communication “unlocks hidden literacy” and “gives a voice” to those with very evident language-based and communication-based disabilities induce nausea in me because these assumptions are wrong entirely (as we have seen earlier, output is basically facilitator-determined) and because – if these assumptions are acted on, and if programmes are modified – the person experiencing serious language/communication disabilities is likely to lose much of his/her existing support without a proper basis in the evidence. And the loss of such supports can only do more damage than would be done if Facilitated Communication were not even tried.
Facilitated Communication has never found validation in rigorous scientific testing, and many professional associations have actually written resolutions against the use of Facilitated Communication. As with any non-validated method of support, Facilitated Communication has no place in the support packages offered to people who cannot express themselves linguistically.
So, as an autistic person who has some documented communication difficulties himself, I am not disposed to accepting Facilitated Communication as a validated method of support for people whose difficulties in communication are worse than mine. And the fact that most professionals in Finland blindly accept this method is indeed very worrying for me: it tells of a total lack of scientific thinking on the part of professionals here (and a corresponding lack of training in scientific thinking in the institutions that train them). Obviously, this situation is not good. For this reason, I became a signatory of the Behaviour Analysis Association of Michigan Resolution on the Use of Facilitated Communication.
In this article, I have left out of the discussion the instances of Facilitated Communication producing output that has lead to the unwarranted splitting up of families on the basis of facilitator-originated accusations of sexual abuse. These matters are for another article I would like to write at a later date, when I deal with forensic aspects of the psychology of teaching, learning and development.
I shall include a comment shortly with a set of references for the points made in this article.
Might be worth pointing out that the FCI is now the Institute on Communication and Inclusion, according to the Syracuse University web-pages.
The Institute also refers to FC these days as Supported Typing. It seems that the term ‘facilitated communication’ is a millstone round its neck.