Facilitated communication (FC) is a technique that allegedly allows a person with severe developmental disabilities, especially autism, to communicate at a much higher level than was previously believed possible for that individual. In FC the facilitator supports and steadies the client’s hand over a computer keyboard, thus allowing the client to type messages which reveal “unexpected literacy” (Biklen, 1993) in the form of syntax, fluency, and content which are age-normative or even indicative of superior intelligence. On the surface, the technique can appear to provide nearly miraculous results, with previously nonverbal clients typing poems and carrying on high-level conversations. The technique’s appeal to parents is fairly straightforward: an adolescent who has never developed language skills is suddenly able to tell his parents that he loves them. In addition to the obvious emotional reward of such an experience, the parents are also grateful to discover that their child who was previously found to have severe mental retardation is actually highly intelligent.
With such fantastic results, especially with a disorder so notorious for its poor prognosis, the rapid spread of the technique is unsurprising. FC started with Rosemary Crossley in Australia, and was introduced in the United States in 1990 by Douglas Biklen. By 1994 FC had become widely accepted and used in special education and adult services for the disabled, despite an almost total lack of scientific evidence of its efficacy. In addition to the absence of evidence that FC actually works, there are major logical difficulties with the technique and the theory behind it. FC practitioners believe that a large proportion of people with serious developmental disabilities actually possess normal or superior intelligence that has been hidden by the “prison” of the body (though the technique is used in cases where no physical disabilities exist as well). Furthermore, FC requires believing that a person who has never learned the alphabet, much less the layout of a computer keyboard, could type complicated and coherent messages in the absence of any assistance other than hand support.
The messages are clearly coming from somewhere, however, and experimental studies have almost without exception agreed on the actual source of what is being typed: the facilitator. The basic experimental design used in most of these studies is very simple: the facilitator and client are seated in their usual fashion at a computer keyboard and are shown pictures, which the client is expected to identify via typing. Conditions are set up, however, such that the facilitator and patient each see separate screens, and the facilitator cannot see what the patient sees. Under such conditions, FC works extremely well as long as both participants are seeing the same stimulus. When the pictures are different, however, the answer typed is almost always what was shown to the facilitator. The results of a large number of controlled studies are quite consistent in concluding that FC is communication by the facilitator rather than by the client.
The dangers of FC go well beyond its simple worthlessness, however. By the mid-1990s there was widespread reporting in the media and at professional conferences of allegations of sexual abuse being made through FC. In a review of legal cases involving facilitated communication (Margolin, 1994), legal action had already resulted from FC allegations of sexual abuse in at least five dozen cases in the United States. Recognizing the dangers to patients and their families, as well as the remarkable body of evidence against its usefulness, the American Psychological Association, American Academy of Pediatrics, Ameri-can Academy of Child and Adolescent Psychiatry, and American Academy of Speech and Hearing have all issued official position papers opposing FC as a treatment modality (Campbell et al., 1996).
As with most instances of pseudoscience in psychotherapy, unfortunately, the story does not end there. The Facilitated Communication Institute at Syracuse University, which has trained most of those using FC in the United States, continues to advocate for the use of FC and provide training in the method, as well as selling promotional materials and training videos on its Web site (http://soe.syr.edu/centers_institutes/institute_communication_inclusion/default.aspx).
References:
- Biklen, D. “Communication Unbound: Autism and Praxis.” Harvard Educational Review, 60 (1990): 291–314;
- Biklen, D. Communication Unbound: How Facilitated Communication Is Challenging Traditional Views of Autism and Ability / Disability. New York: Teacher’s College Press, Columbia University, 1993;
- Campbell, M., Schopler, E., Cueva, J. E., and Hallin, A. “Treatment of Autistic Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry, 35(2) (1996): 134–143;
- Crossley, R. “Getting the Words Out: Case Studies in Facilitated Communication Training.” Topics in Language Disorders, 12(4) (1992): 46–59;
- Jacobson, J. W., Mulick, J. A., and Schwartz, A. A. “A History of Facilitated Communication: Science, Pseudoscience, and Antiscience: Science Working Group on Facilitated Communication.” American Psychologist, 50(9) (1995): 750–765;
- Margolin, K. N. “How Shall Facilitated Communication Be Judged? Facilitated Communication and the Legal System.” In H. C. Shane, ed. Facilitated Communication: The Clinical and Social Phenomenon. San Diego: Singular Press, 1994, pp. 227–258;
- Wheeler, D. L., Jacobson, J. W., Paglieri, R. A., and Schwartz, A. A. “An Experimental Assessment of Facilitated Communication.” Mental Retardation, 31 (1993): 49–60.