Facilitating communication is a new method for helping non-speaking individuals to communicate. The basic method is for a facilitator to hold the hand of the non-speaker and help them point to letters on a board or type at a keyboard. It seemed as if this was a breakthrough method, allowing many non- or minimally-speaking individuals to reveal their hidden inner voice. The illusion burst in the early 1990s. The studies showed that the person doing the communication was the one doing it not the client.

The professional community has been skeptical of FC. They have been very cautious of new methods since they were burned by early acceptance of pseudoscience. FC has never left. Like many pseudosciences, once banned from mainstream science because of high quality scientific evidence, it still persists on the fringe, using a variety of dubious methods to fend off criticism and evidence. Many of these methods are used in alternative medicine.

Staking the moral high ground

This method of pseudoscience promotion attacks and stigmatizes professionals who are trying to defend good science. The narrative that has emerged is that those critical of FC are denying that non-speaking people can have hidden cognitive abilities, that they are denying these people a voice and contributing to their marginalization in society, and that such a position is part of a broader position. Nothing could be further from the truth.

The American Speech-Language-Hearing Association has a very clear position paper on FC. They warn practitioners and clients that the methods are not valid. They care about people with speech challenges. They pointed out that using an invalid method violates the rights of the person to their voice, that it distracts from other validation methods, and that there is no proven benefit.

It is the responsibility of professionals to first do no harm and then use methods that are more likely than not to provide benefit. The morality and ethics here are on the side of those who are cautious about new methods with dubious features, but it is easy for proponents of FC to present themselves as the true champions of the non-speaking.

The American Association on Intellectual and Developmental Disabilities does not recommend FC or the Rapid Prompting Method because of the large volume of evidence that it does not work.

We all support the rights of the non-speaking. They want their voices to be heard. We don't minimize the intelligence of those who have deficits of speaking or communicating. No one can make blanket statements about what people with the condition are able to do or not do. FC is for anyone who is non-speaking or minimally speaking.

Deceptive rebranding

Proponents of FC have done a good job of confusing the public and some professionals. One way of changing methods to appear different is to use a different term, or to subtly change the way it is done. The RPM and S2C are two attempts at a new name. The facilitation holds the client's hand or wrist. They hold a letter board in front of the client and then point without physical contact from the facilitation. The changes allow FC proponents to argue that the client is communicating on their own, but this misses the essence of what FC is.

Asha refers to all of these methods with a descriptive term. This is a good technical term that is operational and more scientific. Is the communication dependent on the facilitator? The reason this is important is that it opens the door for the facilitation to be involved in the communication even if they are not 100% responsible for it. There is no evidence that RPM is a valid method.

The science that showed it was not a valid method was the main lesson of FC. The ideomotor effect was used by facilitators to deceive themselves. No one holding the planchette may be aware that they are pointing to the letters, the same process that allows a Ouija board to work. It is subconscious. There is more to the Clever Hans Effect, in which random responses on the part of the client can be crafted into communication by the facilitation.

Videos are a good way to show these effects. I wrote about the case of Rom Houben, who is severely impaired due to an injury. A person who practices FC claims that he can communicate with ease. These claims are patently false as you can see in the video. Houben does not have the ability to hold up his hand, but he is said to be typing quickly and precisely through the facilitation. This is not possible, no matter what happens inside Houben's consciousness. A neurologically intact individual couldn't cue the person in front of them. When tested with blinded information, it became clear that the facilitation was doing all the communication.

The lessons of this video and all the research into FC over the last 30 years are that any method which allows for the inadvertent influence of the facilitator needs to be carefully studied in order to determine who the author of the communication is. Professionals such as the ASHA recommend that any method that is dependent on a facilitator should be avoided.

Hiding in the herd

FC has been in the news for decades due to negative research and opposition from professional groups. Proponents pretend that FC is part of a broader category of legitimate communication methods, called Augmentative and Alternative Communication (AAC), by hiding in the herd. Things like using pictures, letter boards, keyboards, or voice synthesizer are included. These are proven and helpful methods that are non-facilitator dependent.

You may be accused of saying that all non-speaking individuals have no ability to communicate if you say that FC is pseudoscience. This happened in response to a recent article about S2C. In the article, only S2C is referred to, and never any mention of any of the accepted methods. We received an angry e-mail.

In said article, Dr. Hall claimed that there is “little to no science” behind alternative communication for autistic people who do not speak…

He provided links to articles that supported the organization. The e-mailer will learn a valuable lesson about why science-based practitioners need to be precise. We need to deconstruct diagnoses and interventions to their core features if we are to conflate FC with AAC. One of the articles he linked to in order to prove FC works is this one. The eye tracking shows that the clients were pointing at the letters, not the facilitation. This study has nothing to do with the question at hand, but does show another aspect of hiding in the herd.

The subjects in this study were all relatively high cognitive functioning but non-speaking individuals who had several years of experience successfully using a letter board. The board was held on a desk by the facilitator. This appears to be legitimate communication from the subjects. The authors of the study take a defensive tone throughout, but this is being offered as evidence for facilitation dependent methods.

A large variety of activity under a broad umbrella demonstrates another deceptive method of promoting FC. There are people with other issues who are not on the spectrum, and there are people with different strengths and weaknesses. Different methods, levels of training and experience, and a different understanding of what they are doing are some of the things that different facilitators will use. A well-trained facilitator using a valid letter-board method that is not dependent on a client who is non-speaking but has significant cognitive function and is able to communicate cannot be generalized to all clients, just because they are using what is called AAC.

The scientific literature calls FC into question and Proponents of FC don't understand it. Some people communicate differently and we can't expect them to convey the same information as typical people. That isn't a equitur. They don't understand the point of the studies. They were typing what they thought the answers were. This method is dependent on the mental state of the clients.

Conclusion: Facilitated Communication is still pseudoscience

After three decades, Facilitated Communication is still pseudoscience. We can't allow proponents to push these harmful methods into mainstream methods for those who are non-speaking or have impaired communication. We can't be confused by the shell game of shifting branding and trying to pretend that it's all in the same place. The organizations that have figured it out are ASHA and the proponents.

  • Steven Novella is an academic clinical neurologist at the Yale University School of Medicine. He is the host and producer of the popular weekly science show, The Skeptics, Guide to the Universe, and also the author of the daily neuroscience website, Neuro LogicaBlog. The Skeptics Guide to the Universe was published by Dr. Novella, as well as two courses with The Great Courses.

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