Feature

Facilitated Miscommunication

Research into using "facilitated communication" with handicapped children indicates it's not the children who are communicating.

Neville Blampied

Facilitated Communication (FC) is a procedure where a person with normal communicative abilities (the facilitator) assists a handicapped person (the partner) to create written messages using a keyboard or alphabet board. The facilitator usually assists the partner by holding or supporting their hand. In principle this support should be withdrawn over time so that the partner becomes independent, but in practice this rarely happens.

The FC procedure was invented in the 1970s by Rosemary Crossley, an Australian teacher of the handicapped, to help physically handicapped children and was first popularised in the State of Victoria, Australia. In 1989, Douglas Biklen, a sociologist, observed Crossley's work, and on his return to the US he introduced it to special educators and speech therapists. Biklen and his group were soon announcing major breakthroughs, discovering amazing undisclosed literacy and normal intellectual capacities in autistic and intellectually handicapped children. These were very remarkable claims.

Autism is a rare, pervasive developmental disorder which is evident early in life and is marked by intellectual handicap, an extreme lack of responsiveness to other people, gross deficits in language development, and abnormalities such as echolalia (repeating things like advertising jingles over and over again), extreme perseveration in activities, and stereotyped behaviour such as hand flapping, whirling, touching and rocking. Only a minority of autistic children grow up to something approaching normal adulthood, and most continue to exhibit severe intellectual and social deficits and remain dependent on family or institutional care all their lives.

Biklen and his group claim that autistic individuals suffer from "global apraxia", a motor disorder which prevents them from initiating or terminating actions unless they are provided with facilitator support. This apraxia is responsible for their communication difficulties, but when relieved by FC, they are revealed as highly intelligent and literate. There is, however, no neurological evidence for this so-called "global apraxia".

From 1990, use of FC spread rapidly in the US among special educators, speech-language therapists, teacher aides, parents and others concerned with the care of autistic and intellectually handicapped individuals. This occurred without any valid scientific evidence that FC worked.

The critical question for FC is the role of the facilitator in relation to the content of the message. Who is the author of the message -- the handicapped person, or the facilitator who holds their hand and guides it while the message is being typed? Facilitators and proponents of FC generally consider that communication is a social process, but do not hesitate to attribute the intellectual and emotional content of the communication to the partner rather than to the facilitator.

There have now been more than 15 scientific studies of FC designed to discover who the author is in facilitated communications. Two methods have generally been used. In one, single-blind procedures ensure that the facilitator sees one item of information while the partner sees another. Questions are then asked about the item seen. If the facilitator is merely "facilitating" then the replies should be about the item seen by the partner not the facilitator.

Because some proponents of FC argue that autistic children have a "word finding problem" they argue that test formats which require single-word or short answers are unfair. A second procedure was therefore developed to accommodate this objection, in which, while the facilitator is absent, the partner engages in some activity or discussion with the experimenter (e.g., picking flowers or talking about where they went on holiday). When the facilitator returns they are invited to conversationally interact with their partner with the aim finding out what happened in their absence.

Recent research has also taken care to ensure that the facilitators are experienced, that they are used to working with their particular partners, and that the research takes place in familiar and comfortable surroundings, without time pressure. All this is done to counteract criticism of FC research which claimed that the bond between the facilitator and partner was disrupted by the research process.

The results of this controlled, quantitative research have been very clear. When facilitators have access to relevant information, messages are often accurate. When facilitators do not have access, as in single-blind and facilitator-absent procedures, in the vast majority of cases, messages are either clearly wrong or uninterpretable. The conclusion is inescapable: almost always it is the facilitator, not the partner who is the author of the communication.

These negative findings have led a number of professional organizations such as the American Academy of Child & Adolescent Psychiatry, the American Psychological Association and the American Association on Mental Retardation to issue statements describing FC as a controversial and unproven procedure lacking scientific support for claims of its efficacy.

The responses of individual facilitators have ranged from angry rejection of the findings to acceptance and cessation of FC activities. The academic proponents of FC have tried several arguments to counteract the research findings. The most remarkable of these is to say that the research represents "positivist science" (see "Bad Mouthing Science", Nov 1995). This is said to be an inappropriate paradigm of research which should be replaced by the social constructionist paradigm. Within this paradigm, "authorship is viewed as a cultural construction rather than as a fact". Authorship appears not to be an issue even when FC is used to make allegations of sexual abuse against parents and caregivers, and legal actions follow, something which is happening with increasing frequency.

FC is used in New Zealand but the extent of its use is unknown and almost entirely unregulated. In most cases it is highly unlikely that the parents and guardians of the handicapped individuals involved have given their informed consent to their child's participation in this controversial and unproven treatment. "Informed" consent, in this context, would require disclosure of the nature and extent of the negative research evidence as well as positive testimonials for FC. We may well have embarked on another "unfortunate experiment", this time with the intellectually disabled.

At least one of Biklen's associates is now employed in a university Education Department, and at least one research grant has been given to support FC research. However, given the comprehensive and consistently negative findings reported already, further research scarcely seems necessary. Only one scientific question about FC remains worth pursuing: what are the dissociative social and mental process at work in the facilitators such that they can consistently author these communications while denying all conscious knowledge of the fact?

Neville Blampied is in the University of Canterbury's Psychology Department.