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Facilitated communicationFacilitated communication (FC) is a method that purports to help people with speech or expressive problems to point to spell out words and sentences. The goal of the method is to enable the person to use an augmentative communicationdevice independently. Usually, the facilitator holds the person's hand, wristor armin his hand, prompting the patient to pick out letters on a letterboard or keyboard. The facilitator prompts the client to point to letters and puts slight pressure back on the hand, wrist or arm as the client points toward the communication device. Facilitated communication is most often used with persons with developmental disorders, most commonly autismand Down syndrome, populations in which some neurologistsbelieve there is a high incidence of dyspraxia(Bauman, 1993). The practice is controversial, since a majority of controlledstudies have shown that it is not the patient who is producing the words, but the facilitator, who cues the subject (unconsciously) through the observer-expectancy effect. Facilitated communication advocates claim that such results may be due to bad study design, and point out that some controlled studies have shown positive results (i.e., authorship by the user and not the facilitator); also, some FC users can now communicate without any physical support at all, via a gradual process called "fading". The scientific community remains divided on the issue, with a large majority remaining skeptical.
HistoryFacilitated communication first drew attention in Australiain 1977, when Rosemary Crossley, teacher at St. Nicholas Hospital, produced communication from 12 children diagnosed with cerebral palsyand other handicaps and argued that they possessed normal intellegence. These findings were disputed by the hospital and the Health Commission of Victoria; however, in 1979 one of Crossley's students, Anne McDonald, left the hospital after successfully fighting an action for Habeas Corpusin the Supreme Court of Victoria. After continuing controversy the Victorian Government closed the hospital in 1984-5 and rehoused all the residents in the community. Rosemary Crossley wrote a book about the experience called "Annie's Coming Out" in 1982. Facilitated communication gained more credibility when Arthur Schawlow, a Nobel-prize-winning physicist, used it with his autistic son in the early 1980s. His son was later able to type with little support: just a hand on his shoulder. His experience and its effects on the disability community are described on the Stanford Universitywebsite [1]: "They became champions of the technique and were largely responsible for introducing it to the United States, where it remains controversial." In 1989 Douglas Biklen, a sociologist and professor of special education at Syracuse University, investigated Rosemary Crossley's work in Australia. She was then Director of DEAL (Deal Communication Centre), Australia's first federally-funded centre for augmentative communication. Biklen helped popularize the method in the USA and created the Facilitated Communication Institute at Syracuse University [2]. The method spread across the USA, especially due to its seeming success with people with autism, a severe developmental disability accompanied by difficulties with communication. After starting to use the method in Syracuse, Biklen reported startling results in which students with severe autism were producing entire paragraphs of clarity and intellect. This produced an explosion of popularity. Facilitated communication was strongly embraced by many parents of disabledchildren, who hoped that their children were capable of more than had been thought. ConcernsNevertheless, serious questions regarding FC soon began to surface. For example, some autistic FC users appeared not to be looking at the keyboard while typing. However, proponents argue that autistics have trouble looking at something directly and have greater peripheral vision to compensate, and one study suggested that some FC users first scan the keyboard and then type while looking elsewhere [3]. Still others used vocabulary that was apparently beyond their years, many producing poetry of varying complexity. The question naturally arose: how is it that many speaking adults still cannot read but developmentally-disabled children and adults are able to learn written letters, words, and grammar? Proponents argue, citing Chomsky, that the building blocks for language, written or otherwise, are already part of one's brain at birth; that grammar can be picked up by listening to people talk around them; and that autistics in particular are more observant because they are so often regulated to a passive role. Charles Martel Hale, Jr., the co-author of the pro-FC autobiography I Had No Means To Shout!, is a severely autistic man who claims he learned the alphabetfrom watching Wheel of Fortune. A major concern arose when some of the communications emanating from FC accused the parents of autistic children of severe sexual and/or physical abuse; not all such allegations were proven true. (In an evaluation of claims of sexual abuse from children using FC, some children did show evidence of abuse, and the pattern of abuse paralleled the patterns seen in the nondisabled, speaking population [4]). Also disturbing were the reports about facilitated persons that apparently were able to "mind read" the thoughts of their facilitators [5][6]. In late 1993, a Frontline (PBS)documentary highlighting these concerns was televised [7]; FC proponents responded with criticisms of negative bias[8]. Shortly afterwards controlledstudies were done on the method, a majority of which found that it was the facilitator who was unconsciously producing the communication (review of studies until 1995). In these negative studies, practitioners were unintentionally cueing the facilitated person as to which letter to hit, so the resulting letter strings did not represent the thoughts of the students but the expectations of the facilitators. However, some controlled studies did show positive results (i.e., valid authorship by the FC user, e.g. by relaying information unknown to the facilitator) [9], and much debate ensued among scholars and clinicians [10]. In general, positive results were seen in more naturalistic settings, and negative results in more clinical settings. FC proponents argue that in most of the negative studies, the laboratory setting was itself the confounding variable: i.e., communication is inherently very difficult for autistic people, so they can't necessarily be expected to replicate their successes under unfamiliar or even hostile conditions (e.g., those in which continuance of access to FC was contingent upon passing or failing the test). Critics of FC question why people who can give speeches in public and go to college cannot answer a series of simple questions under controlled conditions. Critics also point out that positive results are typically obtained using so-called "qualitative research methods" in which standard experimental controls for bias and subjectivity are weak or non-existent. Harvard Universitypsychologist Daniel Wegner has argued that facilitated communication is a striking example of the ideomotor effect[11], the well-known phenomenon whereby individuals' expectations exert unconscious influence over their motor actions (Daniel Wegner). Even FC users and proponents do acknowledge the possibility of facilitators at times "guiding" users, consciously or unconsciously. Other theorists (Maurer and Donnellan) argue that autism is in significant part a movement disorder, and that there exists a synchronistic "dance" to communication in all mammalian social interaction which accounts for the mixed results in validation studies (http://www.autcom.org/rethinking.html). By the late 1990s, FC had been discredited in the eyes of a majority of scientists [12]and in most educational and treatment centers in North America. In parts of Europe, it has apparently retained greater acceptance. Within the past few years, FC has mounted a comeback in some North American clinical settings. It was inspired by a 60 Minutes II program in the spring 2003 about people with autism who are assumed to have learned to type independently through the use of FC. Scientists at the MIND Institute studied those autistics and were interviewed for the program. They claim that it is likely that most classically diagnosed autistics are misdiagnosed as being retarded, and in fact most likely are very intelligent. Independent TypingClaims have been made that a number of people who began communicating with FC have gone on to type independently (via gradual "fading" of physical support), and in some cases read aloud the words they type. Examples include Jamie Burke [13], Sue Rubin [14], and Sharisa Joy Kochmeister [15]. Without exception, FC users who have achieved independence in typing affirm that the words they typed during facilitation were indeed their own, and that facilitation played a crucial role in helping them overcome their dyspraxia and achieve independence [16]. Critics complain that these cases have not been independently and objectively verified. They are also concerned that the term "independent" is used very loosely, and seems to be applied even when a facilitator physically assists with the communication (i.e., Sue Rubin in the movie "Autism is a World") External links
Categories: Communication| Disability
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