Below is the text of a new Position Statement published by the National Council on Severe Autism urging caution with respect to the authenticity of communications generated via the use of “facilitated” techniques. NCSA strongly supports the wide variety of independent communication efforts by all with autism but is concerned about the rising popularity of several non evidence-based modalities that depend on the support of an intermediary to generate output. For more information regarding Facilitated Communication and related approaches, in addition to evidence-based practices, please review our recent webinar on the topic here.
NCSA Position Statement on Facilitated Communication
NCSA enthusiastically supports efforts to improve independent communication by all those with severe autism, whether the communication is verbal, gestural, written, or through devices such as Alternative and Assistive Communication (AAC) technologies or a keyboard. We cannot support, however, a technique known as Facilitated Communication (FC). The American Speech-Language-Hearing Association (ASHA) defines FC as “a technique that involves a person with a disability pointing to letters, pictures, or objects on a keyboard or on a communication board, typically with physical support from a ‘facilitator.’” This support can take the form of touching the body directly (typically the hand, wrist, elbow or shoulder) or merely holding the letterboard. Studies dating back to the 1990s have repeatedly demonstrated that the products of FC reflect the (often non-conscious) control of the facilitator and do not represent authentic communication by the disabled person. At times, false statements generated by FC practitioners have resulted in devastating outcomes, including false accusations of abuse against parents and others.
For these reasons, NCSA joins ASHA, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the American Association on Intellectual and Developmental Disabilities, the American Psychological Association, the Association for Science in Autism Treatment and over a dozen other national and international organizations in opposing the use of FC.
We also urge caution with regard to newer variants of FC such as the Rapid Prompting Method (RPM) and Spelling to Communicate (S2C). Like FC, these methods rely on the intervention of a partner to facilitate the communication, and therefore carry the risk of conscious or unconscious prompting by the intermediary. Although practitioners regularly contend the output is the independent work of the persons being facilitated, we are concerned that to date no reliable research has confirmed the authenticity of the communications and that practitioners have systematically resisted calls for simple, straightforward verification studies. Such studies would include message-passing tests, where the disabled person is asked to produce information or answer questions the facilitator does not know the answers to, or tests where the facilitator was blinded. While NCSA does not oppose advances in any therapeutic field, we also ask that such advances be evidence-based, and subject to reasonable scientific scrutiny, especially given the tragic history of dangerous and ineffectual interventions of the past, including FC.
Recently, advocates have begun conducting and publishing studies that claim to prove the legitimacy of letter boarding with technologies such as eye-tracking devices, accelerometers, and electroencephalography (EEG). Orthodox speech and language researchers consider the use of such elaborate and marginally relevant technologies a distraction from the fact that practitioners refuse to submit RPM and S2C to basic validity testing. They are also concerned about advocates’ claims that autism is a motor, not cognitive, disorder, which has no support in the research literature, and that people with autism have normal cognition but suffer from short-term memory loss precluding them from participating in such tests.
Additionally, autistic voices are frequently cited as valid sources of representation for use in scientific research and policy development on the federal, state and local levels. However, some of the voices that are alleged to be representative of autistics are actually facilitated through RPM or FC, and should not be presumed valid.
References:
In-depth analysis of FC literature: www.facilitatedcommunication.org.
American Speech Language Hearing Association, Facilitated Communication and Rapid Prompting Method: CEB Position
https://www.asha.org/ce/for-providers/facilitated-communication-and-rapid-prompting-method-ceb-position/
Donvan J, Zucker C. In a Different Key. 2016 Crown Publishers, New York. (See Chapters 33, 34 documenting past abuses of FC.)
Fein D, Kamio Y. Commentary on The Reason I Jump by Naoki Higashida. J. Developmental & Behavioral Pediatrics2014;33(8):539-542. (Here, paywalled but first page is available.)
Mostert M. Facilitated communication since 1995: a review of published studies. J Autism Developmental Disord. 2001;31:287–313. (The abstract reads: “Previous reviews of Facilitated Communication (FC) studies have clearly established that proponents' claims are largely unsubstantiated and that using FC as an intervention for communicatively impaired or noncommunicative individuals is not recommended. However, while FC is less prominent than in the recent past, investigations of the technique's efficacy continue. This review examines published FC studies since the previous major reviews by Jacobson, Mulick, and Schwartz (1995) and Simpson and Myles (1995a). Findings support the conclusions of previous reviews. Furthermore, this review critiques and discounts the claims of two studies purporting to offer empirical evidence of FC efficacy using control procedures.”)
Schlosser RW et al. Rapid Prompting Method and Autism Spectrum Disorder: Systematic Review Exposes Lack of Evidence. Review Journal of Autism and Developmental Disorders, 2019. https://doi.org/10.1007/s40489-019-00175-w. (The abstract reads: “This systematic review is aimed at examining the effectiveness of the rapid prompting method (RPM) for enhancing motor, speech, language, and communication and for decreasing problem behaviors in individuals with autism spectrum disorder (ASD). A multi-faceted search strategy was carried out. A range of participant and study variables and risk and bias indicators were identified for data extraction. RPM had to be evaluated as an intervention using a research design capable of empirical demonstration of RPM’s effects. No studies met the inclusion criteria, resulting in an empty review that documents a meaningful knowledge gap. Controlled trials of RPM are warranted. Given the striking similarities between RPM and Facilitated Communication, research that examines the authorship of RPM-produced messages needs to be conducted.”)
Adopted by NCSA Board of Directors, June 24, 2021