Autism and facilitated communication can help nonverbal people with autism express themselves in place of speech. The method involves a facilitator helping an autistic person type on a computer keyboard or point to symbols that represent phrases or messages in order to communicate. The effectiveness of this method has been criticized by some autism experts. Is facilitated communication (FC) a good option for nonverbal people with autism?
Facilitated Communication Overview
Facilitated communication is a type of augmentative and alternative communication (ACC) for nonverbal or speech impaired people with conditions such as autism, brain damage, cerebral palsy, strokes, intellectual impairment or Down syndrome. In FC, a facilitator offers physical and emotional support as the person with autism communicates. The facilitator supports the autistic person's arm, wrist or hand to help him type or point to a communication device, such as a keyboard, an electronic device or a picture board.
Rosemary Crossley, Ph.D., created FC while working with a group of teenagers with cerebral palsy in the 1970s when working as a teacher. She taught them how to communicate through spelling. Crossley went on to find the Ann McDonald Centre in Australia that focuses on using ACC methods, particularly FC, to help people with limited to no speech communicate. DEAL stands for Dignity, Education, Advocacy and Language.
Douglas Bilken, a professor at Syracuse University, studied Crossley's work in Australia and brought the FC technique to the US. He used FC with a number of people with autism and found it to be extremely effective. He founded the Facilitated Communication Institute at Syracuse University in 1992, which is now known as the Institute on Communication and Inclusion (ICI). ICI is considered one of the leading authorities on FC in the US and internationally. It is a top voice in supporting autism and facilitated communication techniques.
Thousands of people with severe speech impairments all over the world now use FC, but it is not widely accepted as a credible alternative communication technique. In fact, major health organizations in the US have spoken out against FC. The supporters of the technique boast the effectiveness of the method while the critics claim it is pseudoscience.
Benefits of FC for Autism
The most obvious FC benefit is that it provides a voice for autistic people with limited to no speech. Other benefits include:
- The facilitator provides emotional support to the person with autism and helps make the communication process less stressful.
- The method of typing into a keyboard, using electronic devices or pointing to symbols, letters or images is easy for a person with autism with severe impairments to understand and maneuver.
- The facilitator's physical assistance helps a person who has problems maintaining their attention on a task or handling body movements stay focused on communicating and handling the FC devices.
Criticism of Facilitated Communication
Critics of FC believe that it is ineffective and possibly harmful to some individuals with autism. The main criticism is the question of who is actually communicating. A number of autism experts believe that facilitator is the only one communicating in this technique. They claim that the physical intervention of the facilitator guiding the autistic person's arm makes it impossible to figure out if any of the communication comes from the autistic person.
Detractors claim FC could possibly do more harm than good because the needs of the nonverbal or speech impaired person are not being met. If the facilitator is controlling all communication without any participation from the client, this could be stressful and even frightening to the client. A 1993 PBS Frontline documentary on FC, Prisoners of Silence, compared it to playing with an Ouija board. After reviewing controlled studies that described cases where facilitators appeared to be answering questions while clients were completely disengaged from the process, the American Psychological Association (APA) issued a 1994 resolution that there is "no scientifically demonstrated support for its (FC) efficacy."
Many mainstream medical organizations have publicly stated that they do not support the use of FC. These organizations include the American Academy of Pediatrics (AAP), American Speech-Language-Hearing Association (ASHA), American Association on Intellectual and Developmental Disabilities (AAIDD) and the American Academy of Child and Adolescent Psychiatry (AACAP).
Is Autism and Facilitated Communication Effective?
Is FC a viable autism support tool? The recent studies that discredited the technique and the strong opposition from the mainstream medical community appear to show that FC is not an effective alternative communication method. However, despite the harsh criticism, there is still a significant number of people within the autism and speech impaired communities who claim that FC is effective and beneficial. More research may be necessary to determine the effectiveness of FC, why it works for some but not others, and if there are ways to better empower a speech impaired person with the help of communication devices.