Facilitated Facilitated Communication (FC)Communication (FC)

(Should Facilitated Communication still (Should Facilitated Communication still be used? Can it be relied upon?)be used? Can it be relied upon?)

Nicole SaundersNicole SaundersNovember 22, 2005November 22, 2005

What is Facilitated What is Facilitated Communication? Communication?

Facilitated communication is a procedure in Facilitated communication is a procedure in which a facilitator uses some degree of which a facilitator uses some degree of physical assistance to help a client spell out physical assistance to help a client spell out messages by touching letters on a letter messages by touching letters on a letter display (Biklen, 1990).display (Biklen, 1990).

A Facilitator normally supports a client's hand, A Facilitator normally supports a client's hand, wrist or arm while that person uses a wrist or arm while that person uses a communicator to spell out words, phrases or communicator to spell out words, phrases or sentences (Autism Society Canada, 2005). sentences (Autism Society Canada, 2005).

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

Where did it all begin? Where did it all begin?

Australia 1970 Australia 1970 Rosemary Crossely started (FC) by Rosemary Crossely started (FC) by encouraging a woman which was diagnosed with encouraging a woman which was diagnosed with cerebral palsy to communicate by acting as her cerebral palsy to communicate by acting as her facilitator (National Autistic Society, 2004). facilitator (National Autistic Society, 2004).

Crossely then went on to establish in 1986: DEAL Crossely then went on to establish in 1986: DEAL Communication Centre in Melbourne Communication Centre in Melbourne

DEAL was based on the theory that the language skills DEAL was based on the theory that the language skills of people with autism and other communication of people with autism and other communication disorders were not as impaired as previous notion disorders were not as impaired as previous notion (National Autistic Society, 2004). (National Autistic Society, 2004).

Late 1980’s Late 1980’s Douglas Biklen introduced to Douglas Biklen introduced to the United States (University of Syracuse)the United States (University of Syracuse)

Biklen obtained a Ph.D. in Social Science from Biklen obtained a Ph.D. in Social Science from Syracuse University in 1973. Syracuse University in 1973.

Biklen was on a research project in Australia, Biklen was on a research project in Australia, while he was there he observed Crossely’s while he was there he observed Crossely’s work. He returned to the United States where work. He returned to the United States where he presented FC to speech therapists and he presented FC to speech therapists and special educators working with nonverbal special educators working with nonverbal autistic students. autistic students.

Biklen’s ResearchBiklen’s Research

Once Biklen and some colleagues tried the Once Biklen and some colleagues tried the technique they reported to find unbelievable technique they reported to find unbelievable results. Nonverbal students were results. Nonverbal students were communicating to others. communicating to others.

It was said that their reports did not “present It was said that their reports did not “present accounts of consistent benefit of the technique accounts of consistent benefit of the technique were unambiguous or standardized measures were unambiguous or standardized measures of communication used for baseline and of communication used for baseline and posttreatment performance assessment.” posttreatment performance assessment.” (Montee et al., 1995) (Montee et al., 1995)

Controversy Grew while Controversy Grew while FC use spreadFC use spread

As Biklen and colleagues published their As Biklen and colleagues published their findings, many people became excited. findings, many people became excited. FC brought them feelings of hope to have FC brought them feelings of hope to have a chance to communicate with loved a chance to communicate with loved ones which was always a hopeless ones which was always a hopeless dream before. dream before.

Institutions were established and Institutions were established and programs to facilitated communication programs to facilitated communication were developed.were developed.

Stories Stories

Jeff Powell a student at Baker high school in Jeff Powell a student at Baker high school in Syracuse Syracuse ("Autism held me hostage for ("Autism held me hostage for seventeen years but not any more because seventeen years but not any more because now I can talk.")now I can talk.")

["I cry a lot about my disability ... It makes me ["I cry a lot about my disability ... It makes me feel bad when I can't do my work by myself." feel bad when I can't do my work by myself." Andrew, age 6]Andrew, age 6]

[Please heed my need. I need to heed others. I [Please heed my need. I need to heed others. I this reason think the world they need heed like this reason think the world they need heed like we heed brothers." Manny, 2nd grade]we heed brothers." Manny, 2nd grade] (Palfreman, 1993)(Palfreman, 1993)

Facilitated Facilitated Communication a hoax? Communication a hoax?

As time went by more and more studies As time went by more and more studies were disproving the positive belief of FC. were disproving the positive belief of FC.

Many studies were showing that the Many studies were showing that the facilitator was actually the one typing the facilitator was actually the one typing the message. message.

Ethical issues are also a concern.Ethical issues are also a concern.

For Example:For Example: Wheeler, Jacobson, Paglieri, and Schwartz (1993)Wheeler, Jacobson, Paglieri, and Schwartz (1993)

Pictures manipulated by using a T-screen apparatus Pictures manipulated by using a T-screen apparatus (showed different pictures to the student and the facilitator(showed different pictures to the student and the facilitator

Showed:Showed: (a) the client-facilitator pair typed the name of the picture (a) the client-facilitator pair typed the name of the picture

correctly only when the facilitator was shown the same correctly only when the facilitator was shown the same picturepicture

(b) the pair never typed the name of the picture correctly (b) the pair never typed the name of the picture correctly when the facilitator was not shown the same picturewhen the facilitator was not shown the same picture

(c) when the facilitator was shown a picture that was not (c) when the facilitator was shown a picture that was not the same as the picture shown to the client, the pair typed the same as the picture shown to the client, the pair typed the name of the picture shown to the facilitator. the name of the picture shown to the facilitator.

Other studies that Other studies that demonstrated the same demonstrated the same thingthing

Hudson, Melita, & Arnold, 1993Hudson, Melita, & Arnold, 1993 Moore, Donovan, & Hudson, 1993 Moore, Donovan, & Hudson, 1993 Moore, Donovan, Hudson, Dykstra, & Moore, Donovan, Hudson, Dykstra, &

Lawrence, 1993Lawrence, 1993 Regal, Rooney, & Wandas, 1994 Regal, Rooney, & Wandas, 1994

(Montee et al., 1995)(Montee et al., 1995)

““Research has consistently shown that it is the facilitators (not the Research has consistently shown that it is the facilitators (not the clients) who determine the content of the typed message (though clients) who determine the content of the typed message (though unconsciously).” as outlined by Condillac and Perry, (2003) unconsciously).” as outlined by Condillac and Perry, (2003)

Ethical Issues presentedEthical Issues presented(Dayan & Minnes, 1995)(Dayan & Minnes, 1995)

RESPECT FOR THE DIGNITY OF RESPECT FOR THE DIGNITY OF PERSONS PERSONS

A) Informed Consent-A) Informed Consent-

Facilitator consent rather then the Facilitator consent rather then the students consent. students consent.

b) Confidentiality- third party b) Confidentiality- third party

2. Responsible caring- 2. Responsible caring- evaluate potential risks evaluate potential risks and benefits of a treatment and to do no harm. and benefits of a treatment and to do no harm.

a) a) IQ testing- may mislead results and create IQ testing- may mislead results and create higher expectations of individual which can higher expectations of individual which can lead to depression, lower self esteem etc. lead to depression, lower self esteem etc.

Alternative- Raven's Progressive Matrices and Alternative- Raven's Progressive Matrices and the Leiter International Performance Scale (Do the Leiter International Performance Scale (Do not require verbal responses.) not require verbal responses.)

b) Chance of Mis-use and Mis-interpretationb) Chance of Mis-use and Mis-interpretationEx. Cases of reported child abuse. Ex. Cases of reported child abuse.

Reaction? Reaction?

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

Biklen’s ReactionsBiklen’s Reactions

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

Research to compensate Research to compensate for Biklen’s concernsfor Biklen’s concerns

(Montee et al., 1995)(Montee et al., 1995) 7 pairs (client-facilitator)7 pairs (client-facilitator) Normal settingNormal setting 12- 24 activities, 24 pictures presented to each client12- 24 activities, 24 pictures presented to each client Three conditions:Three conditions:1.1. The facilitator and client had access to the same The facilitator and client had access to the same

informationinformation2.2. The facilitator did not have access to the picture or The facilitator did not have access to the picture or

activityactivity3.3. The facilitator was given false information about the The facilitator was given false information about the

picture or activity.picture or activity.

ResultsResults

Activity Activity 80% of the time in the false 80% of the time in the false condition trials (unknown to the condition trials (unknown to the facilitator), the client answered (typed) facilitator), the client answered (typed) the correct answer of the facilitator.the correct answer of the facilitator.

When the facilitator knew what was When the facilitator knew what was presented to the student, the students presented to the student, the students answered correctly 87%answered correctly 87%

Results continuedResults continued

Picture Picture When the facilitator knew what When the facilitator knew what was presented to the student, the student was presented to the student, the student answered correctly 75% of the time. answered correctly 75% of the time.

66% of the trails when the student was 66% of the trails when the student was presented with a different picture then the presented with a different picture then the facilitator, the student answered correctly facilitator, the student answered correctly for the facilitators picture for the facilitators picture

Biklen published Biklen published Facilitated Facilitated Communication DigestCommunication Digest which included which included outlines for the use of FC.outlines for the use of FC.

Perhaps the technique is useful however, Perhaps the technique is useful however, the faultiness is within the teaching of the faultiness is within the teaching of how to correctly use FC. how to correctly use FC.

Biklen, (1993c) also states that controlled Biklen, (1993c) also states that controlled studies by Calculator & Singer, 1992; studies by Calculator & Singer, 1992; Vazquez, 1994; Weiss, Wagner & Vazquez, 1994; Weiss, Wagner & Bauman, in press all prove FC works Bauman, in press all prove FC works properlyproperly

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

TodayToday

Institutions still promoting and teaching Institutions still promoting and teaching FCFC

Ex. Syracruse University, Indiana Institute Ex. Syracruse University, Indiana Institute on Disability and Communityon Disability and Community

Autism Society Canada Autism Society Canada ““Experts report that FC as a stand-alone Experts report that FC as a stand-alone

program approach is ineffective and potentially program approach is ineffective and potentially harmful for individuals with ASD.” (Autism harmful for individuals with ASD.” (Autism Society Canada, 2005) Society Canada, 2005)

American Psychological AssociationAmerican Psychological Association““THEREFORE, BE IT RESOLVED that APA THEREFORE, BE IT RESOLVED that APA

adopts the position that facilitated adopts the position that facilitated communication is a controversial and communication is a controversial and unproved communicative procedure with no unproved communicative procedure with no scientifically demonstrated support for its scientifically demonstrated support for its efficacy.” (APA online, 1994) efficacy.” (APA online, 1994)

Graduate StudiesGraduate Studies

Patricia Minnes, (Developmental Patricia Minnes, (Developmental disabilities) Ph.D. in Developmental disabilities) Ph.D. in Developmental Psychology -Psychology -

Queen’s UniversityQueen’s University

ReferencesReferences APA online: American Psychological Association: APA online: American Psychological Association: Council Policy Manual : Council Policy Manual :

Scientific Affairs., Scientific Affairs., 19941994http://www.apa.org/about/division/cpmscientific.html#6http://www.apa.org/about/division/cpmscientific.html#6 Autism Society Canada: Autism Society Canada: Communication systems., Communication systems., 20052005http://www.autismsocietycanada.ca/approaches_to_treatment/communication_systemshttp://www.autismsocietycanada.ca/approaches_to_treatment/communication_systems/index_e.html/index_e.html

Biklen, D. (1990). Communication unbound: Autism and praxis.Biklen, D. (1990). Communication unbound: Autism and praxis.Harvard Harvard

Educational ReviewEducational Review, 60, 291-315., 60, 291-315. Biklen, D. (1993c). Questions and answers about facilitated Biklen, D. (1993c). Questions and answers about facilitated

communication.communication.Facilitated Communication DigestFacilitated Communication Digest, 2, 10-14., 2, 10-14. Condillac, R. & Perry, A. (2003). Evidence Practices for Children and Adolescence Condillac, R. & Perry, A. (2003). Evidence Practices for Children and Adolescence

with Autism Spectrum Disorder: with Autism Spectrum Disorder: Review of literature and practice guide.Review of literature and practice guide. Dayan, J., Minnes, P. (1995). Canadian Psychology. Dayan, J., Minnes, P. (1995). Canadian Psychology. Ethical issues Ethical issues

related to the use of facilitated communication techniques with persons related to the use of facilitated communication techniques with persons with autismwith autism

Montee, B.B., Miltenberger, R.G., & Wittrock, D. (1995) Montee, B.B., Miltenberger, R.G., & Wittrock, D. (1995) Journal of Applied Journal of Applied Behavior Analysis. Behavior Analysis. An experimental analysis of facilitated communication, An experimental analysis of facilitated communication, 28, 189-200. 28, 189-200.

National Autistic Society: National Autistic Society: Facilitated CommunicationFacilitated Communication., 2004., 2004

http://http://www.nas.org.uk/nas/jsp/polopoly.jsp?dwww.nas.org.uk/nas/jsp/polopoly.jsp?d=297&a=3285=297&a=3285 Palfreman, Jon. PBS Frontline: Palfreman, Jon. PBS Frontline: Prisoners of Silence., Prisoners of Silence., October 19, 1993October 19, 1993

http://www.pbs.org/wgbh/pages/frontline/programs/transcripts/1202.htmlhttp://www.pbs.org/wgbh/pages/frontline/programs/transcripts/1202.html Syracuse University: Syracuse University: Introducing teaching and leadershipIntroducing teaching and leadership

http://http://soeweb.syr.edu/Teaching/intro_tl/biklen_i.htmlsoeweb.syr.edu/Teaching/intro_tl/biklen_i.html University of Syracuse, Facilitated Communication Institute: University of Syracuse, Facilitated Communication Institute: Facilitated Facilitated

communicationcommunication

http://soeweb.syr.edu/thefci/http://soeweb.syr.edu/thefci/ Wheeler, D. L., Jacobson, J. W., Paglieri, R. A., & Schwartz, A. A. (1993). Wheeler, D. L., Jacobson, J. W., Paglieri, R. A., & Schwartz, A. A. (1993).

An experimental assessment of facilitated communication.An experimental assessment of facilitated communication.Mental Mental RetardationRetardation, 31, 49-60 , 31, 49-60

Discussion:Discussion:

What do you think…What do you think… 1. Facilitated communication began to be 1. Facilitated communication began to be

used before any significant testing of used before any significant testing of validity was conducted. validity was conducted.

2. Even after all of the negative evidence 2. Even after all of the negative evidence provided in study after study, FC is still provided in study after study, FC is still practiced and taught today. practiced and taught today.