I recently read the article “After years with no way to communicate, Newburgh teen finds her voice.” Like so many other similar stories, this heartwarming narrative gives an account of how a young women is using supported typing to “communicate.” The mother describes how this strategy has helped her teenage daughter to communicate and find her “voice.” Her daughter points to letters on a letter board while another person (the facilitator) supports the daughter’s wrist during the process of typing.
Although it is good to read positive stories like this, it is important that we alert parents and professionals to the pitfalls involved in describing “supported or assisted typing” as a communication strategy.
A basic requirement for viewing a message as a communication attempt is that the individual is able to demonstrate that s/he independently composed the message. We need to make sure that it is the intent of the individual who compiles the message that is reflected in the message, and not the intent of the facilitator (who supports the wrist) who is guiding the process. If we talk about a person’s “voice,” we imply that it is an independently compiled message, which we cannot say if the person’s hand is supported. This is not a new technique, and it is important for parents and professionals to be aware of some of the past history in the use of supported typing.
Let’s back up a bit and give a bit more background on the history of this strategy.
The History of Facilitated Communication or Supported Typing
Facilitated communication (FC), supported or assisted typing, or hand-over-hand, is a scientifically discredited technique (Ref 1) that aims to promote communication of people with autism who are unable to speak. The facilitator guides the individual’s arm or hand and attempts to support them in typing on an alphabet board or other device. The use of this technique with students with severe autism has been rejected in different research studies, as well as in court cases in the early 1990s. A more contemporary systematic review of research on the topic also confirms that there are no research studies pointing to the effectiveness of this strategy in recent years. The primary reason why the use of the strategy is not supported is the fact that it is very difficult to prove authorship of messages constructed in this way.
The controversy about authorship, however, does not necessarily imply that the facilitators are purposely influencing the message construction (Ref 2). It has been reported that facilitators are often unaware that they might be influencing this process of message construction.
I became most aware of the complexity of issues when I was president of the International Society for Augmentative and Alternative Communication (ISAAC) in 2012–14 as we worked to develop a position statement on Facilitated Communication and Supported Typing for the ISAAC community. The purpose of this effort was to provide guidance to professionals and parents and to raise awareness of the challenges involved in using this technique.
At the time, we interacted with parents, professionals, and individuals who earlier on in their life used this strategy, and it became clear that
- facilitated communication meant different things to different people; but also that
- some individuals who have used the technique felt that “their way of communication” was being attacked.
I found this troubling as I struggled to understand why one would not like to be made aware of the pitfalls you could encounter in using a specific strategy. Generally, if we are going to use a specific strategy or method, we do want to know the risks involved in using it, whether we want to continue using it or not. Surely, having this knowledge enables one to be more alert in how one uses this strategy rather than merely rejecting the research evidence available.
The Resurfacing of the Strategy
The mother in the video (in the above-referenced article) talked about how the child’s life has changed since using this strategy. I do not think there is any doubt that this intervention can have a positive effect on an individual with severe autism. The mere fact that you have someone sitting next to you who is physically supporting your hand or arm while you type and compose a message is an intimate and close experience. This supportive presence of a facilitator could make a significant difference to a person with autism, regardless of whether the individual with autism can type independent messages. Physical support and sitting close to the client is an intense level of support to someone who feels emotionally insecure and isolated.
In my recent book, titled Augmentative and Alternative Communication: Engagement and Participation, I addressed the importance of emotional resonance and engagement in promoting the process of meaning-making in interaction.
The real issue is not whether the individual with autism can gain from the support of a facilitator, but rather whether the messages constructed in this way can really be regarded as those of the person with autism. The messages can only be regarded as those of the individual with autism if it can be proved that the messages were constructed independently of another person. The issue of independence in the construction of the message is therefore central.
Conclusion
Rather than trying to sell Facilitated Communication as a communication strategy (which it is not), can we regard it as a means to support an individual in accessing the alphabet on a keyboard? Learning to access a keyboard in this way is not insignificant. Some individuals who use this strategy will learn to construct their own independent messages, and some will not. However, as we increase awareness of the need for independent message construction, we might become more cautious in labeling the messages constructed as being those of the individual with autism.
What do you think?
References:
- Montee, B B; Miltenberger, R G; Wittrock, D; Watkins, N; Rheinberger, A; Stackhaus, J (1995). “An experimental analysis of facilitated communication.” Journal of Applied Behavior Analysis. 28 (2): 189–200.
doi:10.1901/jaba.1995.28-189. PMC 1279809. PMID 7601804. - International Society for Augmentative Alternative Communication (2014). “ISAAC Position Statement on Facilitated Communication: International Society for Augmentative and Alternative Communication.” Augmentative and Alternative Communication. 30 (4): 357–358.