Facts About Facilitated Communication
by Douglas Biklen
from http://www.autism-resources.com/papers/facts_about_FC

FACILITATED COMMUNICATION SHOULD NEVER INVOLVE GUIDING A PERSON AS HE OR SHE ATTEMPTS TO POINT OR TYPE.

The idea is never to guide the person to a selection. In
facilitation a parent, friend, teacher, speech language clinician or
other communication partner provides physical and emotional support
as the person with a communication disability tries to point in order
to communicate. The method can involve pointing at pictures or
letters. The physical support may include: assistance in isolating
the index finger; stabilizing the arm to overcome tremor; backward
resistance on the arm to slow the pace of pointing or to overcome
impulsiveness; a touch of the forearm, elbow, or shoulder to help the
person initiate typing; or pulling back on the arm or wrist to help
the person not strike a target repetitively. Emotional support
involves providing encouragement but not direction.

THERE IS EMPIRICAL RESEARCH TO SUPPORT THE VALIDITY OF FACILITATED COMMUNICATION.

Controlled studies (e.g. Intellectual Disabilities Review Panel,
1989; Calculator & Singer, 1992; Velazquez, in press), observational
studies (Biklen, 1990 and 1993; Attwood & Remington Gurney, 1992) and
autobiographical accounts (e.g. Eastham, 1992; Oppenheim, 1974;
Nolan, 1987; and Crossley & McDonald, 1980) provide evidence that the
method works. One explanation why some researchers (e.g. Wheeler et
al, 1993; Szempruch et al, in press) have failed to replicate these
positive results could be that their tests are not valid.
Before discounting the potential competence of individuals with
disabilities, researchers have the obligation to question the
competence of their research designs.

FACILITATORS CAN INADVERTENTLY INFLUENCE (i.e. cuing, leading) THE COMMUNICATION OF THE PERSON TO WHOM THEY ARE GIVING SUPPORT.

Influence definitely can occur (see, for example, Biklen, 1990;
Biklen, 1992; Biklen 1993; and Intellectual Disability Review Panel
[IDRP], 1989). The IDRP study (1989) demonstrated that an individual
who was able to type uninfluenced communication could also be
susceptible to influence. *Hence it is important for facilitators to
monitor themselves and work to minimize influence* (Schubert &
Biklen, 1993). But, the fact that a person may be subject to
facilitator influence does not automatically indicate that the person
is not capable of uninfluenced communication!

IT IS NOT NECESSARY FOR FACILITATORS TO BELIEVE IN TH COMPETENCE AND
THE ABILITY OF THE PERSON WITH A DISABILITY IN ORDER TO MAKE
FACILITATED COMMUNICATION WORK.

There is no need to prejudge a person’s ability until it has been
demonstrated. Indeed, many people who have expressed extreme
skepticism about the method have subsequently been successful with it
(Schneiderman in 1993). Nevertheless, we have noted that as
with any instructional situation, it is important for the
facilitator/teacher to express confidence in the individual’s ability
to succeed with the method, much as a coach expresses confidence in a
person’s ability to learn a new sport or as a teacher exudes optimism
that a young student can learn to read or do math problems.

FACILITATED COMMUNICATION CAN BE TESTED.

When introducing a person to facilitation for the first time, it
is valuable not to be testing the individual, allowing a the person
time to build his or her confidence with the new means of
communicating. This does not mean that it is not possible to test
facilitated communication. Clearly, for the method to gain wide
acceptance, it must be examined rigorously through many kinds of
tests and research. It is gratifying that despite the potential
problem that research tests could intrude upon and upset the
communication process, researchers are achieving success in
controlled studies (IDRP, 1989; Vazquez, in press; Calculator &
Singer, 1992), and in observational ones (Attwood & Remington-Gurney,
1992). While our own research is comprised mainly of long term
observational studies (Biklen et al, 1992; Biklen & Schubert, 1991),
some researchers at the Facilitated Communication Institute are now
beginning to design controlled experiments as well.

FACILITATED COMMUNICATION IS NOT A NEW METHOD.

Facilitated communication is known to have been used at least
three decades ago (see Oppenheim, 1974) and was discovered
independently in Sweden (see account in Schawlow & Schawlow, 1985),
Canada (Eastham, 1992), Denmark (Johnson, 1988), Australia (Crossley
& McDonald, 1980), and the U.S. (Oppenheim, 1974; Schawlow &
Schawlow, 1985; L. v. Board of Education, 1990; Berger, 1992). Only
recently has the method spread widely; this has occasioned active
debate about the method.

SOME PEOPLE USING FACILITATED COMMUNICATION HAVE MADE ALLEGATIONS OF
SEXUAL ABUSE. SOME HAVE BEEN SUBSTANTIATED.

Some individuals have made allegations of abuse, but there is no
evidence that the numbers of allegations by individuals using
facilitation is proportionally different than the numbers of
allegations made by speaking people. In a survey made at the SUNY
Health Sciences Center, it was found for a given time period that of
6 case in which individuals alleged they had been sexually abused,
for 4 of them there was physical evidence they had been abused
(Botash, 1993). Cases can lead to court convictions (Randall, 1993)
and/or confessions by the accused. As with allegations made by the
nondisabled population, some allegations may be unfounded and others
simply impossible to prove.

IT IS POSSIBLE TO EXPLORE WHETHER ALLEGATIONS OF ABUSE MADE THROUGH
FACILITATION ARE THE WORDS OF THE PERSON WITH THE DISABILITY OR THE
PRODUCT OF FACILITATOR INFLUENCE.

In an investigation, a second facilitator could be brought in to
provide facilitation. If the person repeats his or her allegation
with the same or similar details, this would indicate that the
allegation originates with the person who uses facilitation to
communicate.

SOME COURTS ARE NOW ACCEPTING TESTIMONY GIVEN THROUGH FACILITATED
COMMUNICATION.

Testimony was given in an abuse case in Wichita Kansas; a jury
found the accused guilty (Randall in Wichita Eagle, March 30 and 31,
1993). Also, the Supreme Court Appellate Division in New York state
ruled that testimony given by such alternative means must be
evaluated in each individual case (In the Matter of Luz P., Opinion &
Order, January 14, 1993; Martin, 1993); to prove her competence to be
a witness in her own case, Luz P. took and passed tests verifying her
ability to communicate her own thoughts through facilitation (see
Martin, “Facilitation theory tested”, The Times Herald Record, July
31, 1993.)

FACILITATED COMMUNICATION REQUIRES TRAINED FACILITATORS.

It is important for potential facilitators to learn about the
particular physical problems the method is intended to address; it is
useful for new facilitators to practice technique, to learn how to
monitor the person’s eyes on the target, to teach finger isolation,
pacing and other skills associated with working toward independent
typing, to formulate getting-started activities and to work on fading
physical support. Facilitators must also learn how to foster control
by the person with the communication impairment over his or her
typing, and to avoid facilitator influence, whether physical
influence or verbal influence (e.g. completing sentences for the
person, anticipating next letters and words).

PARENTS AND FRIENDS CAN LEARN TO BE GOOD FACILITATORS.

Some teachers and some parents seem to pick up the method
quickly; for others it takes longer to learn. But many parents and
teachers for whom it was initially difficult have been able to learn
the method and to achieve confidence in their ability with it.

IN ORDER TO COMMUNICATE THROUGH TYPING, THE PERSON MUST KNOW HOW TO
READ.

People do need to know how to read in order to be able to type
out words. Interestingly, many people now using facilitated
communication have already learned how to read but have had no means
of showing that ability until they could type. Not surprisingly,
individuals who use facilitated communication reveal varying literacy
skills. If individuals cannot read, they can be introduced to
facilitation in which they point to pictures. The manner of teaching
them reading would be the same as for people who can speak.

FACILITATED COMMUNICATION CAN BE USED IN COMBINATION WITH OTHER FORMS
OF EXPRESSION.

People who use facilitated communication may also continue to
work on developing their speech; some people can say the words or
letters they are about to type and some can speak a sentence that
they have typed, even though they may be unable to carry on an open
ended conversation. Others may continue to develop proficiency with
manual communication. And certainly, using facilitated communication
does not preclude learning other skills, such as independent living
or employment related skills.

WE CANNOT SAY WITH WHAT PERCENTAGE OF PEOPLE FACILITATED
COMMUNICATION WILL WORK.

The method *may* be useful for any individuals who cannot speak
or whose speech is highly echoed or in other ways limited and who
cannot point independently *and* reliably. But we have not selected
a random group of people classified as autistic or developmentally
disabled and tried the method with them, so we cannot say with what
percentage it might work. Based on our experience, however, we
believe that the method will be found to be useful for most people
who have difficulties with speech and who cannot point reliably.

FACILITATED COMMUNICATION DOES NOT WORK EQUALLY WELL WITH EVERYONE.

As with any method, it may not be effective with some persons and
will predictably have varying success with others. Success may be
related to neurological factors (e.g. tremor, low and high muscle
tone, lack of proprioceptive awareness) and to socio-emotional
factors such as amount and nature of support, educational experience,
and opportunities to practice.

NOT EVERYONE USING FACILITATION CAN TYPE FLUENT CONVERSATIONAL
COMMUNICATION.

People vary in their communicative skills. Not surprisingly,
individuals who share the same facilitator(s) demonstrate different
levels of fluency as well as personal concerns or themes, distinctive
phraseology or expressions, and other stylistic differences.

IF A PERSON TYPES FLUENTLY WITH ONE OR TWO PEOPLE, INITIALLY HE OR
SHE MAY STILL HAVE DIFFICULTY TYPING WITH OTHERS.

Since confidence plays a big part in a person’s success, changing
facilitators may involve a period of adjustment and building or
rebuilding of confidence.

FACILITATED COMMUNICATION IS NOT A CURE FOR AUTISM OR OTHER
DEVELOPMENTAL DISABILITIES.

It is a means of communicating, not a cure.

PEOPLE WHO USE FACILITATION TO COMMUNICATE MAY NOT ALWAYS NEED A
FACILITATOR. THE GOAL IS INDEPENDENCE.

Already some individuals in the U.S. and many more in Australia
have demonstrated that they can learn to type independently. Because
independent typing is a realizable goal, Rosemary Crossley has
referred to the method as “Facilitated communication training.”

THE FACT THAT SOME PEOPLE USING FACILITATED COMMUNICATION CAN WRITE
POETRY AND DEMONSTRATE HIGH LEVEL THINKING ABILITIES DOES NOT
NECESSARILY MEAN THAT THEY CAN CONTROL ALL OF THEIR BEHAVIOR.

The same neurological problems that make reliable independent
pointing and speaking difficult may also affect other behavior, for
example toileting. The fact that a person can type letters and thus
communicate does not logically mean that all other difficulties would
be eradicated, particularly if these involve stereotypies or
obsessive compulsive behavior. At the same time, some people improve
in these areas as their expressive communication developed.

THE FACT THAT A PERSON CAN POINT EFFECTIVELY SOMETIMES DOES NOT
GUARANTEE THAT HE OR SHE CAN DO IT ALL OF THE TIME, ON DEMAND.

The issue is not whether a person can point, but whether he or she
can do so reliably, that is on demand, for multiple step tasks as
well as one-step ones. It is well known that there are neurological
reasons other than intellect to explain why multiple step tasks might
be difficult for people with developmental disabilities (see Kelso &
Tuller, 1981; Miller, 1985; Maurer, 1992). Recent studies in the
field of autism (e.g. Courchesne, 1993; Bauman in ASA, 1993) as well
as in spina bifida, Down syndrome, Williams syndrome, Joubert
syndrome, and hydrocephalus (see Leiner et al, 1991; Ziegler, 1990;
and Bordarier & Aicardi, 1990) identify cerebellar abnormalities. It
is known that the cerebellum plays an important role in regulating
complex motor tasks. The idea of facilitation is to help individuals
overcome particular difficulties with motor tasks. Over time, with
practice and with improved confidence, individuals are expected to
become able to type reliably, without a facilitator.
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