Facilitated Communication: A Dangerous Psuedo-Science

January 31st, 2013
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For those who do not know, I work at a program which, among other things, provides services in training autistic persons.   I admit that I’m not an expert in the area of autism, and there is much that I do not know or understand, but my experience in this area has exposed me to some very disturbing psuedoscientific claims.

One of the most disturbing that I have seen is something known as “Facilitated Communication.”  Facilitated Communications (Or FC, also known as assisted typing, assisted communications, alternative and augmentative communication and by other similar terms) came about in the 1970′s after the hypothesis was advanced that persons with autism do not have any kind of mental, emotional or cognitive disability, but instead are perfectly capable of understanding and interacting with the world as anyone else, but cannot do so because their body will not let them or because the interface between their brain and body somehow distorts their actions.

This idea is entirely false.  Autism does not involve any physical disability and persons with autism generally have perfectly functional fine motor control and are entirely capable of manipulating objects, typing and so on.   In reality, autism is a developmental condition that has an especially pronounced effect on the development of social skills and communications.   Persons with autism commonly lack the ability to communicate and to properly perceive and display appropriate social cues.

The effects of autism can be extremely mild or severe.  Indeed, there is an entire “spectrum” of possible effects and different individuals experience these differently.  Some individuals are perfectly capable of following directions, interacting with others and behaving normally in most situations, but do experience some level of difficulty in social situations, anxiety and difficulty with subtle cues.  Others are more severely disabled, unable to understand basic communications or conduct themselves in a normal manner.  Some become obsessed with repetitive behavior, are prone to being withdrawn or cannot understand basic tasks and normal instructions.

It’s not uncommon for autistic to be speech impaired.  Again, this runs the gamut.  Some can speak as well as anyone else, while others have trouble finding words and correctly using grammar.   It’s not uncommon for communication-impaired autistic to become extremely agitated when they are asked to speak more than a few brief words.  Some autistic are able to understand spoken communications with reasonable accuracy, but cannot find the proper words to express concepts back.

It is important to recognize that these issues are not the result of some kind of physical problem.   Although genuine pathological speech difficulties can exist in autistic, this is not the reason why severely autistic persons cannot communicate easily.  The problem exist regardless of the medium.   An autistic person who cannot find the proper words to speak will not be able to find the proper words to type or point to them on a chart.

Facilitated Communications ignores this proven fact.  Its champions claim that autistics simply need some help in getting their fingers to the correct key or the correct letter on a chart.   As such, a “facilitator” is provided whose job it is to help guide their hand to the correct letter.   Of course, this presents a huge problem.   As long as the facilitator is guiding their hand, it’s impossible to know whose choice it was to pick a given letter or word.   In fact, in many cases, just looking at the action, it seems undeniable that the facilitator is the one moving their hand.

This does not mean that the facilitator always knows that they are making the decision, the ideomotor effect plays a big role and can make it seem very convincing, even to the facilitator, that the words are coming from the disabled individual.   Worse still, most disabled individuals embrace the attention and praise that facilitated communications offers them, even if they are not really communicating.

Regardless of what the facilitators and clients may say (and you can’t tell who is saying it anyway), double-blind studies have provided rock-solid evidence to contradict these claims.

Here is an excellent video on the subject (though twenty years old):

Amazingly, despite this evidence being available back in 1993, Facilitated Communications has only grown in popularity.

Facilitated communications has some very staunch advocates.  Worse still, the otherwise respectable University of Syracuse has a very active program in promoting FC.   Millions of dollars have been sunk into this and similar programs and the result has been the widespread use of this largely discredited method.

Here is what Syracuse University has to say about it:

Facilitated Communication (FC) or Supported Typing is a form of alternative and augmentative communication (AAC) in which people with disabilities and communication impairments express themselves by pointing (e.g. at pictures, letters, or objects) and, more commonly, by typing (e.g. in a keyboard). The method involves a communication partner who may provide emotional encouragement, communication supports (e.g., monitoring to make sure the person looks at the keyboard and checks for typographical errors) and a variety of physical supports, for example to slow and stabilize the person’s movement, to inhibit impulsive pointing, or to spur the person to initiate pointing; the facilitator should never move or lead the person.

It often is referred to alternatively as Facilitated Communication Training because the goal is independent typing, nearly independent typing (e.g., a hand on the shoulder or intermittent touch) or a combination of speaking with typing – some individuals have developed the ability to read text aloud and/or to speak before and as they are typing. Typing to communicate promotes access to social interaction, academics and participation in inclusive schools and communities.

The person who provides support for communication is called a facilitator or communication support person. A facilitator can be a teacher or other professional, a family member or a friend. The person who receives the support is called the communication aid user or FC User.

It should be noted that while the stated goal is independent typing, this is often not achieved.   Even if the individual does eventually reach the point where they can type with minimal interactions of the facilitator, the possibility that they are using non-verbal cues and simply responding to the facilitators direction cannot be discounted.  In fact, the idea that a person would be fully capable of writing long and complex statements, but only when someone is leaning over them, goes against all we know about autism and also basic reason.

Here is what some FC users say:

So very systematic and focused in the work and my learning showing my intelligence and depth of many subjects to the all folks who did not believe in my smartness. I find much serenity and lots of peace on my day to day activities can’t do so without facilitated communication. The enhacnement of a very cloistered life to openness and more solid durable communication.
Sujit Kurup, High School student and FC user, June 2010.

“Without FC I am imprisoned in a body that cannot reveal who I really am. This form of communication has changed my life and it is no full of possibilities and opportunities for me to be heard in the world.”
Tyler Fihe, college student and FC user.

Powerful statements, but lets not forget, we don’t actually know that these are coming from the individual and not the facilitator.
FC clients have gone to college with their facilitators (usually at state expense) and obtained employment, with a facilitator in tow the entire time.   They have also made some disturbing and unfounded accusations, such as sexual abuse, which turned out to be entirely false and nothing but a figment in the imagination of the facilitator.

But not all institutions have accepted Facilitated Communications.  In 1994, amid the growing popularity of FC, the American Psycological Association passed a resolution including the following language:

Facilitated communication is a process by which a facilitator supports the hand or arm of a communicatively impaired individual while using a keyboard or typing device. It has been claimed that this process enables persons with autism or mental retardation to communicate. Studies have repeatedly demonstrated that facilitated communication is not a scientifically valid technique for individuals with autism or mental retardation. In particular, information obtained via facilitated communication should not be used to confirm or deny allegations of abuse or to make diagnostic or treatment decisions.

THEREFORE, BE IT RESOLVED that APA adopts the position that facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy.

It is long past time for the promoters of facilitated communications to show some real evidence and for the validity of this concept to be evaluated based on solid, controlled, scientific testing.   As emotionally appealing as some claims may be, if they are false, they are worthless or worse.  If that is the case (which it certainly seems to be) then there should be no tolerance for otherwise respectable universities, therapeutic programs or government departments to be involved in this nonsense.

I should finally note that nobody at my place of work regularly uses facilitated communications, and if they did, I might need to resign from work completely. However, prospective clients sometimes come through with their “facilitator.” In such cases, there’s not much I can do, as saying something is not going to change any minds or result in anything other than an ugly confrontation. That said, it’s an issue I sometimes grapple with.

Additional information:

This entry was posted on Thursday, January 31st, 2013 at 10:12 am and is filed under Bad Science, Education, Obfuscation, Quackery. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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16 Responses to “Facilitated Communication: A Dangerous Psuedo-Science”

  1. 1
    DV82XL Says:

    I have run into this particular crock in the real world as well, and it is one of the worse self-delusion frauds out there. The faith of believers is so strong that it makes most fundies look wishy-washy and it is impossible to reason with them. Frontline (PBS) hit the nail on the head when it compared FC to Ouija.

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  2. 2
    Josh Says:

    Wow. I had not heard of this before, but it looks very obviously to be bull. You can see clearly in the video waht is going on and anyone with even the slightest bit of healthy skepticism ought to immediately call foul.

    How can it be that this still exists in anything other than fringe groups? It was debunked so completely in the early 1990′s and big groups like the APA took notice and rejected it. I would think that their stand on it would carry some weight. Why does this still go on at fully accredited universities? Surely someone has questioned that kind of a program and asked them to pony up to some double-blind tests, which is not an unreasonable thing to ask at a university, or so I thought.

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  3. 3
    Bill T Says:

    I have seen non-verbal or semi-verbal autistics who can type on a keyboard but it’s never complex statements. They can just type or indicate some basic stuff on their own and picture boards work well for some people too (boards with illustrations of things like eating, toilet, outdoors, bed and other basic things) these can work well to show their desire at a given time because it avoids needing to translate the concept into words, which is what some struggle with even if they can understand the concept.

    Therefore autistics can move their hands and fingers just fine. That is not where the problem lays and if you knew even the first thing about it then you’d realize that quickly. Anyone with any knowledge of autism therapy or how autistic clients can communicate should reject this completely.

    I have seen this too and for some parents and caregivers its just too good to let go of and that makes it very hard for any legitimate service because the first thing you would do is say that this is not real, which will simply turn them away. They will be very defiant and cling to it and reject anyone who disputes it.

    Of course not all family and care givers buy into this but some do and you can’t tell them otherwise. I blame more the pushers of this. I’m sure some of them believe it, but there are whole schools and organizations out there that push this and I think we just shouldn’t allow that.

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  4. 4
    Calli Arcale Says:

    It’s just agonizing to read about the accusations of abuse, that you know exist only in the minds of the communicators. Agonizing to think of what the families suffered, what the children suffered, and also to think of how agonizing that would be for the communicator — it’s the stuff of a classic tragedy, that, realizing not only that these children have been put through horror based on a false accusation, but that you yourself had unwittingly fabricated the entire thing. It’s no wonder people cling to the belief that FC is real.

    But it’s not. It’s Clever Hans all over again, but with human beings.

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  5. 5
    drbuzz0 Says:

    If you want my explanation for why this can still thrive in institutions of higher learning and other respectable services, I’ll give it to you, but it’s rather cynical.

    I think it’s just about money. Families and care-givers see this apparently working better than their wildest dreams and are inspired to open their wallets and give a big donation.

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  6. 6
    Brian-M Says:

    This inspired me to look up the “Prisoners of Silence” episode of Frontline and watch the entire thing. (The embedded video is a condensed version.) If anyone else wants to watch the entire program, here are the links…

    Part 1 (14:42) http://www.youtube.com/watch?v=HXw8Ksvyt5Y
    Part 2 (14:10) http://www.youtube.com/watch?v=19eAMcgn2QU
    Part 3 (14:13) http://www.youtube.com/watch?v=oHqRTDW9Irk
    Part 4 (11:25) http://www.youtube.com/watch?v=PctmzkrJmcg

    (Also noticed a minor typo in this blog entry… The phrase “subtle queues” should be “subtle cues”.)

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  7. 7
    Random Integer Says:

    Oh, to what extent is this thing undermining the quality of higher education anyways? And why do people still believe in something that has been proven to be fake 20 years ago? These people themselves are, perhaps, just as retarded. Besides, sexual abuse allegations just rip a family apart, and why do courts/prosecutors even give a crap about this unverified and untrusted evidence and keep innocent people in jail with it? (Yeah, maybe this world is more stupid than I thought it is).

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  8. 8
    Arthur Golden Says:

    I just found your 4 day-old blog entry when I did a Google search of “facilitated communication” as hit #12. While I disagree with your opinion that Facilitated Communication is one of the most disturbing pseudoscientific claims, I wish to respond to some of your factual claims about FC that I know are wrong.

    So far, I have read only about the first third of your blog entry. I will have to get back to you later with a more detailed comment, but based on what I have read so far, I do want to make the one specific comment that you seem to be unaware that there a significant number of persons with autism who are completely nonverbal, such as my own 41 year-old son Ben. When my son was the first child evaluated by Speech Pathologist Dr. Howard Shane at the Children’s Medical Center in Boston Massachusetts in 1977 at age 5, he was almost completely noncommunicative, despite 1-1/2 years of a state-of the-art special education preschool program.

    I hope to post a further comment soon.

    Arthur Golden

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  9. 9
    drbuzz0 Says:

            Arthur Golden said:

    I just found your 4 day-old blog entry when I did a Google search of “facilitated communication” as hit #12. While I disagree with your opinion that Facilitated Communication is one of the most disturbing pseudoscientific claims, I wish to respond to some of your factual claims about FC that I know are wrong.

    So far, I have read only about the first third of your blog entry. I will have to get back to you later with a more detailed comment, but based on what I have read so far, I do want to make the one specific comment that you seem to be unaware that there a significant number of persons with autism who are completely nonverbal, such as my own 41 year-old son Ben. When my son was the first child evaluated by Speech Pathologist Dr. Howard Shane at the Children’s Medical Center in Boston Massachusetts in 1977 at age 5, he was almost completely noncommunicative, despite 1-1/2 years of a state-of the-art special education preschool program.

    I hope to post a further comment soon.

    Arthur Golden

    No, I know this. And some of those who are non-verbal do communicate more effectively through typing or visual aids. But if they can’t, then it’s not because they can’t move their fingers without someone holding them.

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  10. 10
    Tom Smith Says:

    I’m a long time autism residential worker who used FC for 2 years in the early Nineties. I also was skeptical about it when I first heard of it but then I was skeptical about all autism interventions having used them for twenty years before FC came along. I voted FC down at the first staff meeting in which it was introduced. Later I saw someone using it in another part of the treatment center and it seemed harmless to me plus we needed something for the communication component of the program. We all started using it and it was fun. We also knew about the studies and that we were pioneering the intervention and knew it’s limitations. We adjusted and used it intensely for a few years. While the communication was most certainly “dicey”, we were all convinced something “valid” about it was happening. In any case it was a huge boon for our program and positive outcomes with our clients. Never in my 20 years working with them had we had more success in “curing” the worse of their behavior problems, All were taken off meds and negative behaviors were a thing of the past. This was an ICF facility and we had a state of the art data collection system which showed all the changes.

    Please don’t follow the crowd on this. Used carefully and with the proper “adjustments”, it is a great intervention. Beyond that it is a door to understanding both autism and the nature of human communication. Yes, it’s that potentially important. Please try to understand the autism treatment situation and keep this in perspective. Nothing we did in autism had much scientific validity. In fact none of it did.

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  11. 11
    DV82XL Says:

            Tom Smith said:

    I Nothing we did in autism had much scientific validity. In fact none of it did.

    That’s the problem. Without the rules of science claims of all sorts can be made based on people’s perceptions.

    Lack of proper controls means that you cannot dismiss secondary effects such as improvements in behavior due to effects such as more attention being given to the individual and other confounding variables. It is simply not good enough to claim that you are convinced something valid is there because the possibly that the experimenters are fooling themselves is too great. Worse, this would not be the first time this has happened.

    Furthermore the deeper issue is that beyond anecdotal evidence, some explanation as to why this effect disappears in controlled studies has to be forthcoming.

    I feel for those working in this field because I know that there has been so little progress and the temptation to see something positive must be overwhelming, but in the long run chasing something like this without the discipline of science wastes resources and time that might be better spent looking for more valid methodologies.

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  12. 12
    ebohlman Says:

    One major problem: Augmentative and Assistive Communication is a legitimate field. “Facilitated Communication” just isn’t a legitimate part of it. AAC encompasses all methods of communication that substitute for lacking speech.

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  13. 13
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  14. 14
    Marliah Says:

    Facilitated communication is garbage. Take it from me a mom who was sold this bill of goods for her son, he had previously been using pecs symbols to request basic needs. Then at the advice of a new therapist ,who completely duped me in my desperate cry for help, he was “taught” to communicate using facilitated communication and encouraged to remove the pecs system. I was told how smart my son was that he could read and knew all this information that he had no way of knowing, for instance I was “told” he had said the capital of some middle eastern country to his therapist, he had no way of knowing that, we had no studied world history, we don’t watch the news….. For years we bought into this nonsense, my sons behavior took a major turn for the worse, he began to have violent outbursts and things were horrible. My husband and I decided to do some basic testing of our own, my husband would flash a very basic picture to my son (a dog, a cat, etc) and say type what you saw, me “facilitating” guess what it was never right, not once, not even close… We finally tossed the FC garbage where it belonged, in the fireplace and burned it. It surely does mimic the ouija board and is as evil….it’s a lie perpetrated on desperate parents and disabled children, run far away from it, expose the truth about it, I have made it a mission of mine to get the truth out on this. May no one else be taken in by it. We trashed this thing a year ago and are finally starting to get some peace back in our home, I grieve for the years we lost with our son when we could have actually been teaching him something real.

    By the way my son is starting to use pecs again now, finally. I had him do some matching games for me recently and he matched all the uppercase and lowercase letters and was quite proud of himself, so I gave him a basic word match game and said match the words. Nope, nothing, basic words to pictures (cat, dog, cow, fish). He was never reading the way they tried to make me believe…but now that that scam is over with I am going to work hard on teaching him how to read!

    Please parents, therapists, caregivers, take warning. Facilitated communication is not only a hoax it ruins lives.

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  15. 15
    Mary Ann Harrington Says:

    I have always done PECs in conjunction with FC and recommended others do the same. Pecs teaches spontaneous requesting and recognition of communication partners. It also is not dependent on an accurate pointing response. It strengthens conscious ego dependent selections. It is not facilitator dependent. FC for me is more of a connection or merging of our subconscious minds and allows for expanded knowing of the autistic typist to come through. It also helps me get into my own higher self. What is needed is open communication and sharing. By the way, initial stages of Pecs, prompting from behind similar to FC is used for maximum results. My friends have lead me to believe knowledge is in the soul. This knowledge can be accessed by merging at a subconscious level using a telepathic form of FC. The ego conscious independent desires and wishes is strengthened more by using such strategies, as PECS, WECS, and Voice Output programs. My experience has been that RPM type strategies also have an energetic component. During RPM, I think of myself as talking and my friends with nonverbal autism as listening. When using FC, I feel I allow my nonverbal friends to do most of the talking and I listen. PECS, WECS, RPM, Voice output software, FC, Gestures, and signs should all be used, depending on your purpose.

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  16. 16
    DV82XL Says:

            Mary Ann Harrington said:

    I My friends have lead me to believe knowledge is in the soul. This knowledge can be accessed by merging at a subconscious level using a telepathic form of FC.

    Someone open a window, the smell of B.S. is starting to make me want to vomit. Practice this sort of mental masterbation on nitwits like yourself – leave autistic kids alone

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