This site is proudly sponsored by 
Vicnet
Facilitated communication training is a teaching strategy of particular relevance to individuals with severe communication impairments (SCI) who do not have severe physical impairments but nonetheless have had difficulty acquiring handwriting and manual signing skills. Many such individuals are diagnosed as intellectually impaired and/or autistic. Through FCT numbers of such individuals have achieved functional communication, often revealing unexpected understanding and academic potential.
DEAL, Australia's first center solely devoted to the needs of people with SCI, opened in 1986, staffed by a multi-disciplinary team with experience in using augmentative and alternative communication (AAC) with individuals with severe motor impairments, such as those associated with cerebral palsy. The center's clientele was not restricted to particular diagnostic groups and by the end of 1989 DEAL staff had seen 634 individuals with SCI associated with a wide range of developmental and acquired disabilities, of whom 495 (78%) had been labelled as intellectually impaired.(2)
Three quarters of the clients labelled intellectually impaired were able to walk, but over 90% of them showed some difficulty in using their hands effectively. Most had received considerable sign language training, generally using the Makaton (3) vocabulary, nonetheless only four were using more than 100 signs and even these had difficulty in reproducing the signs accurately. It appeared that aided communication would be more functional than signing for this group, both because of their difficulties with sign acquisition and the lack of sign language skills in the community at large.
In aided communication, a set of choices is displayed on a communication aid or display, and the user makes selections from these choices, either by pointing directly or using switches to control electronic scanners. Demands on fine motor skills, motor planning and memory are reduced.
As it happens, people with SCI who use wheelchairs have more communication aid options than people who walk. This is because large communication aids and displays can be mounted on wheelchair trays, and access strategies involving headpointers, eye-pointing boards or scanners are feasible for wheelchair users but impractical for individuals who walk. People with SCI who walk need to use small, easily portable communication aids with their hands.
In 1986 it became clear that even the minimal hand skills needed for successful communication aid access were lacking in most of the individuals labelled as autistic and/or intellectually impaired who attended DEAL. Many of the problems seen had not been perceived as treatable neuro-motor dvsfunctions, but rather as an integral part of intellectual impairment. One example is perseveration - people who perseverate when pointing hit the same location repeatedly. When Joe answered two questions correctly by pointing to the 'yes' symbol; and then continued pointing to 'yes' even though the answer to the next three questions was 'no' it was assumed that he either did not know the difference between 'yes' and 'no' or did not understand (or know the answer to) the questions. However, when a facilitator withdrew Joe's hand from the communication display after each selection, and ensured that Joe paused before making the next selection, Joe was able to answer all five questions correctly, indicating that the problem was one of execution, not of understanding.
DEAL developed a training program using facilitation to assist individuals like Joe to point successfully. This was defined as clear, unambiguous selection of cleared items from an array whether of real objects, pictures, symbols, written words, or letters. The most common hand function impairments seen were poor eye-hand co-ordination, low muscle tone, impulsivity, and perseveration. The remedial strategies varied from problem to problem. Because Joe tended to perseverate when he used a communication aid, a facilitator helped him withdraw his hand after each selection until a pattern of withdrawal and pause became automatic and Joe could use the aid effectively without facilitation.
No-one was excluded from FCT because of previous negative intellectual assessments. Intellectual assessment of individuals with severe expressive problems is difficult and unreliable. Communication training is a pre-requisite for accurate assessment. The pre-requisite for admission to the FCT program was need - the need to improve a person's hand function in order that he/she could use easily portable communication aids effectively. Literacy was not a prerequisite. Individuals who could not spell used picture and/or symbol boards and, if possible, were included in literacy programs.
In the 1970's I used facilitation with individuals with cerebral palsy. (4) After DEAL started using FCT with people diagnosed as autistic and/or intellectually impaired in 1986 we became aware of a number of earlier examples of facilitated communication. Some parents such as the Easthams and the Schawlows used facilitation with their children, and some teachers or therapists such as Rosalind Oppenheim and Carol Berger used facilitation with groups of students. (5)
Nonetheless, relatively little use was made of facilitation as a communication/teaching technique in North America until 1990, when Douglas Biklen published an article "Communication Unbound; Autism and Praxis. " (6) after spending a month at DEAL studying FCT in 1989. (7) Since 1990 numerous FCT programs have sprung into existence across the U.S. and Canada. It is estimated that thousands of individuals labelled autistic and/or intellectually impaired are now using communication aids with facilitation, many of whom are now communicating verbally, through facilitated typing, for the first time in their lives.
During the Fall semester 1992 I was attached to Syracuse Universityâs new Facilitated Communication Institute, of which Biklen is Director. As well as giving a graduate course on Augmentative and Alternative Communication (AAC), I delivered workshops on FCT for a number of centers in the U.S. and Canada, and met or had telephone contact with individuals from all over North America who were implementing FCT programs.
The dominant impression I received was that facilitation was spreading like wildfire, and generating enormous excitement and enthusiasm in both caregivers and professionals. There has been extensive coverage of FCT throughout North America, by both the print and electronic media. At least five states, Georgia, Maine, New England, Pennsylvania and Texas, have FCT newsletters as does the FC Institute at Syracuse. Presentations on FCT have been delivered at the conferences of professional bodies such as ASSMD, ISAAC, ASHA, often in conjunction with pre-conference workshops on FCT. The TASH conference in November 1992 scheduled 20 presentations on FCT. Numbers of academic articles on FCT have appeared or are in press, and a wide range of research projects examining aspects of FCT is under way.
Not all the literature on FCT is positive. Articles described test failures and court cases in which people communicating with facilitation were not allowed to give evidence. These negative reports raise issues of concern, which are discussed below. Also of concern are the irrational beliefs held by some supporters of FCI'.
The four dominant elements of facilitation mythology in North America are:
These beliefs have probably gained credence because facilitation has spread so rapidly, and programs have been implemented by caregivers or teachers who heard about facilitation through the media and did not have access to instructional material.
Some professionals criticise Biklen and others for the uncontrolled spread of FCT. To an outsider this seems absurd - the spread of FCT reflects aspects of American society that are not controllable by any individuals. Many of these are good - in North America I found a much more positive attitude to people with disabilities overall than generally prevails in Australia.
Australians tend to believe the worst about anything and have a great faith in professional opinion. The greatest crime any Australian professional can commit is to raise false hopes. Any statement about the potential of an individual with disabilities is always likely to err on the negative and many professionals feel that their intervention has been successful if they have brought the parents of a child with disabilities to a realistic acceptance of the child's limited potential for improvement. If the child later makes unexpected improvements or does things, such as spell, which challenge the negative information reiterated repeatedly to the parents, a major re-adjustment is required, which many families find difficult or impossible.
In North America there appears to be a willingness to challenge negative assessments and many more parents and professionals remain open to the possibility of improvement in a child with disabilities. The North American media's inexhaustible appetite for human interest stories, including unexpected achievements by people with disabilities, ensures that the existence of a new treatment is widely reported. While this may mean that some 'way-out' therapies are given too much credence, it also reduces the chances of an individual missing out on a potentially beneficial treatment.
Australian and American responses to media stories differ; in Australia, most parents interested in a therapy reported in the media would contact professionals for their opinions of the therapy or for help in implementation. Few parents would try a therapy themselves without professional input. (8) The American response is "Let's give it a go" and numerous parents or teachers implemented FCT programs after seeing short media items about FCT. It is to these people's credit that they tried; many had some success with facilitation but it is scarcely surprising that their lack of detailed information on what, why and how led to mistakes and misapprehensions.
One surprisingly common misapprehension found in both professionals and lay people is that FCT is the only form of non-speech communication and that if a person is unable to spell with facilitation there are no alternatives available. Of course that is totally wrong - there are numerous AAC strategies and technologies available to people with SCI. Facilitation is merely a technique for developing communication aid access skills.
Unfortunately, while North America led the world in the development of AAC in the 1970s there still seems to be widespread ignorance about its possible uses. Many speech-language pathologists still believe that AAC intervention is only appropriate for individuals with no speech whatsoever. To say that people with some speech are not entitled to extend their communication by using AAC is as absurd as saying that anyone with some sight is an inappropriate candidate for glasses.
The attitude that AAC is only for a minority of individuals with SCI is compounded by the history of non-speech communication, which has typically been diagnosis-based rather- than need-based. Deaf people have used manual sign for more than two centuries. People with cerebral palsy (CP) have used communication boards for two decades. In the late seventies computerised communication aids became available and were used by people with CP and other severe physical impairments, but were not seen as an option for people with diagnoses such as autism or intellectual impairments. Some people with these diagnoses were offered training in a restricted set of manual signs; many were not offered any alternative to speech.
Consequently, in 1990 when Biklen's article was published, the communication needs of most people with SCI had not been met2 . Few of their caregivers and teachers had any familiarity with AAC and thus saw FCT as the alternative to speech. McNaughten (1992) reports about professionals feeling "cut-off from their clients when no option other than FC will even be considered by parents" and clients who are being 'prevented from exploring the many techniques which have been successfully applied in the AAC field".
Restricted access to AAC may be partially responsible for the fixation on FCT. A contributing factor is a mythology about literacy, SCI. and FCT. Elements of this mythology are:
While an expectation of literacy skills in individuals with SCI is a positive change from the earlier negative mythology that people who could not talk could not learn to read, it is quite incorrect to suggest that literacy skills are either innate or mystically acquired.
It is true that many individuals with severe communication impairments have acquired some literacy skills from incidental exposure to written language regardless of whether they have had access to formal education. Their families and teachers are often unaware of their skills because their lack of speech and handwriting skills has prevented them from telling anyone that they can react. Such individuals may behave in ways which indicate an interest in or understanding of written language. Maria always looks at the TV guide before she switches on the television. Liz goes to the bookshelves and gets the book her father wants, Tony puts on whatever song staff request even though none of the records have covers, Dean goes up to the notice board every time a new notice is pinned up. These skills are not mysteriously acquired, they are picked up from considerable exposure to written language, in newspapers, magazines, junk mail and on product labels, TV commercials, greeting cards and even t-shirts, which most of us have thrust upon us in our society.
It is also true that there are individuals with SCI who do not demonstrate literacy skills at their initial AAC assessments. Some may have sensory impairments which have affected their ability to pick up on written language without special aids or teaching strategies. Some have lacked the incidental exposure -necessary to acquire written language without formal teaching (e.g. individuals who have spent prolonged time in residential care and individuals whose caregivers are not literate). Some individuals have had exposure but took no interest in written language, perhaps because they did not see it as having any relevance to them. All of these individuals are likely to benefit from exposure to meaningful written language and all are candidates for literacy programs. The fact that someone does not demonstrate literacy skills at their initial assessment does not mean that they do not have the potential to acquire literacy skills.
Spelling is the most empowering communication strategy for people with SCI because it is the only strategy which allows the user access to an unrestricted vocabulary, but there will always be some individuals with SCI for whom the acquisition of literacy skills is difficult or impossible. A large number of nonspeech communication options such as picture and symbol displays which do not require reading or spelling are available for this group. These options are also appropriate for Young children and individuals in the process of acquiring spelling skills. It is important that individuals with literacy skills are enabled to use and extend them, individuals without literacy skills are given opportunities to develop them and individual" with literacy limitations are given access to communication strategies which do not depend on reading or spelling.
Facilitation is a strategy for assisting individuals to develop pointing skills; it is not yoked to spelling and it can be used when appropriate to assist non-spellers to mike selections from their communication displays. Many literate individuals with SCI will never need facilitation because they have unimpaired handskills and many individuals who cannot spell would benefit from facilitation.
There seems to be a much greater tolerance for atypical behavior in the U.S. than there is in Australia - indeed, this tolerance has itself become institutionalized in some settings. The young adult I was assessing in a group home head-butted a staff member; I told him off and he did not do it again. Later the service's psychologist told me that staff were forbidden to tell off residents because it was psychological abuse. To me it appeared that there was some confusion between accepting the resident and accepting his behaviour. and that the uncritical acceptance of inappropriate behaviour denied the resident the possibility of change.
In FCT the most common example of unwillingness to interfere with 'natural' behaviours occurs with aid users who point or type without looking. Some of these individuals glance occasionally at their aids, some use peripheral vision and some do not appear to look at all. In addition to its role in accurate independent pointing, eye/hand coordination is important to aid users for other reasons. First, keeping an eye on the display or printed Output is the best protection for the facilitated aid user against communication breakdown or being 'helped' to say something s/he doesn't intend. Second, while communication pragmatics are always difficult for aid users -how do you maintain eye contact with the person you're talking to while using a communication aid - there is no doubt that looking at your communication aid is preferable to gazing off into space or looking round the room, which is what most individuals with unaddressed eye/hand co-ordination problems do. Even if such behavior doesn't raise doubts as to the origin of the communication, it certainly suggests that the aid user is not interested in the conversation.
Facilitation can improve eye/hand co-ordination. The facilitator can monitor the aid user's eye contact and remind him/her to look at the communication display. At first the facilitator may have to inhibit the student's pointing until s/he is looking at the target area. Where the student's head is actually turned away from the target a physical prompt may be needed to attain a midline, eyes down position. Eye/hand co-ordination usually improves rapidly when these practices are followed consistently.
In Australia implementing eye/hand co-ordination programs is not a problem - it is accepted that independent pointing is unlikely to be accurate unless the pointer looks at the target, and that if some interference with the aid user's usual visual patterns is necessary to achieve this, so be it. In North America facilitators are often reluctant to insist on eye contact, possibly for fear of infringing individual liberties. (9) All kinds of explanations are given for not looking -"He's using peripheral vision"; "She says she's got an image of the keyboard in her head" and so on.
Communication aid users in Australia give similar explanations for not looking, or not looking directly, and to some extent they are true. It is also true that peripheral vision is in its nature monocular, and stereoscopic vision is necessary for accurate depth perception. While some individuals can type successfully without looking when their facilitators support their hands, monitor the communication aid position and give them feedback on their output, it is notable that, without exception, aid users who did not initially make good eye contact their aids when they were receiving facilitation look intently at their aids when they progress to using them without facilitation. It is doubtful that these individuals would ever have achieved independent aid access if their facilitators had not improved their hand/eye co-ordination.
Uncritical acceptance of typed communication is a problem common to North American and Australian facilitators. Many people seem to believe that because something was typed it is true, and that if it is shown to be untrue then that means the person can't type. The third option, that the person can type, but tells lies, exaggerates, or makes mistakes just like other people, is frequently overlooked. Bound up with this is our society's attitude toward written language, which is generally taken as more serious, more considered than speech.
Currently in North America there appears to be a heightened awareness of the possibility of sexual assault, especially sexual assault by caregivers and many individuals working with people with disabilities appear to be very sensitive to any language of a sexual nature. Unfortunately the mandatory procedures intended to protect individuals from abuse are easier to start than they are to stop. Jim's mother was forbidden to take him home for weekends after a new facilitator asked him what he did on the weekends and he typed three letters of which the first was 'S'. She said 'Do you mean 'sex'?', he nodded, and the facilitator reported that he had been sexually assaulted, precipitating a lengthy inquiry during which home visits were banned.
Another example of willingness to give more credence to something if it's typed is the belief in telepathy which has recently appeared in some North American centers where facilitated communication is used. Typically one or more facilitators believe that one or more aid users are reading their thoughts. Sometimes the facilitators have asked the aid users if they are telepathic and have been told 'yes'.
Some years ago a DEAL client, '.Jill', was said to be telepathic. Jill was attending a regular secondary school when some of her facilitators said she was 'getting into their thoughts'. Jill's mother also thought she wis telepathic and gave examples of situations where Jill had typed out information that was known only to her. At this stage Jill was generally typing with just her mother's hand on her knee. When I asked Jill and her mother to demonstrate Jill's 'telepathy' it became clear that Jill was picking up physical cues from her mother. Unconsciously Jill's mother was moving her hand towards the next letter she expected Jill to hit in an effort to speed up her typing, in the same way as a passenger may press a non-existent accelerator or brake to speed Lip or slow down an incompetent driver. Once she thought Jill was telepathic, she expected Jill to type what she was thinking, so the process became self-reinforcing.
Jill admitted that she had been trying to get cues from her school facilitators, who held her wrist, initially so she could get the answers to school work, and then, once she discovered that it was possible, for fun. Jill knew a fair bit about her facilitators. She would introduce a likely topic into her typing - if they jumped to attention, she would continue exploring it, if not she would erase the typing and it would just seem like a loss of concentration.
Jill's mother was worried that all the typing Jill had ever done had been cued, and that Jill had never been communicating. To show her mother that she really could type Jill did some message-passing tests before going on to type completely independently, with no physical contact from her communication partners. All reports of her being telepathic stopped at this point.
Jill's story was instructive in several ways. First, it showed how stories of telepathy could arise as the result of transmission of information from facilitator to aid user by subtle physical signals. Second, Jill was not a passive participant in the process. She actively sought cues and used her considerable literacy skills to capitalise on the cues she did pick up by using sophisticated word and sentence completion strategies. Third, hand-reading' was a very rewarding activity for Jill. Not only did she get excellent marks in school but her 'paranormal' powers made her the center of attention. She went along with the story that she was telepathic until facilitators refused to work with her because she was invading their privacy. Finally, the 'hand-reading' was possible only because Jill wis getting more support than she needed from her facilitators.
Since Jill's story became widely known among Australian facilitators, DEAL has received no other accounts of telepathy. Consequently the number of North American facilitators who believed their students had telepathic abilities came as a surprise. The reports were localized - some large state-wide FCT programs had never heard mention of telepathy - and typically radiated out from facilitator trainers who believed in telepathy and passed this belief on to trainee facilitators.
In any instance where paranormal abilities are suggested. the facilitation process should be examined closely, both to see if a mechanism for transmission of information can be discerned and to see if the amount of facilitation can be reduced. It should be recognized that the most likely explanation for any incident of 'telepathy' is cueing, whether conscious or unconscious, sought or unsought.
Some of the negative material on FCT referred to above concerns the failure of aid users to "validate " their communication. Those attempting to check that communication produced with facilitation emanates from the aid user and not the facilitator have used three main strategies. The first uses stylistic analysis, which picks up Such things as the aid user consistently using the same unconventional spelling or grammar regardless of who the facilitator is.(10) The second involves analysis of content, looking for instances of the aid user passing information unknown to the facilitator in ordinary conversation. (11) The third involves formal testing, which may be of a fairly intrusive nature. The first two strategies are preferred by educators and speech-language pathologists, the third by psychologists.
In both Australia and North America 'validation' testing of FCT is concentrated in the hands of psychologists. Other disciplines tend to devote their research efforts to longitudinal programs, looking at the response of individuals to FCT over a period of time, and trying to answer such questions as which factors contribute to the success or failure-e of FCT, what is the nature of the language impairments (as opposed to speech impairments) in various groups of FCT users, and what percentage of users achieve independent communication aid access or typing. (13)
Psychologists tend to favor formal tests involving confrontational naming tasks in which an individual is 'confronted" with a question to which one noun is the only acceptable answer. In speech therapy such questions are used diagnostically, in order to ascertain the nature of an individual's language problems, and will show up problems with word-finding and short-term memory. The therapist asking the questions knows the expected answers, of course, and so has a good chance of interpreting any correct responses even when they are mumbled or slurred.
A reasonable analogy for much facilitated communication may be a low-powered transistor radio, which works okay as long as you get it tuned and positioned exactly right and there's no interference. There is a signal there, and the radio is trying to receive the signal, but it works better in some situations than others. If there's interference you can't interpret the signal, and you turn up the volume to try and beat the interference, the mike won't take it and the signal deteriorates into woofs and whistles. Some messages get through the interference better than others - we can make out well-known songs, because we can use our previous knowledge to fill in the gaps in the transmission, but someone talking on an unknown topic isn't comprehensible because we can't anticipate what's going to be said and we have no contextual knowledge to fill in the gaps.
Psychologists testing FC users typically remove all predictability and redundancy from communication (one word without any surrounding context is the only acceptable answer) while adding interference (the test set-up; screens, earphones, white noise). Even if the people tested have no specific language problems affecting their performance on the kind of questions asked, it would be difficult for them to get a message through. If their communication partner/facilitator has been set up to expect a completely different message it may be impossible. Archer criticizes Australian psychologists for "jeering a facilitator for admitting that facilitation is easier to do when the context is known, and forgetting that adults do this with young children and students with delayed speech all the time. it is much easier to repeat clearly and reinforce correctly what might have been said when the context is known. This approach has been accepted for years."(14)
Three psychologists-designed studies involving variations of confrontational naming tests -were released in New York State during my visit. and each study concluded that FCT did not work-that is, that the students involved could not type out information unknown to their facilitators.(15) The 0 . D. Heck study (16) which investigated the use of facilitated typing by twelve individuals with autism is typical. Little attention was paid to training of facilitators or participants. Three staff at O.D. Heck Center attended one or two-day workshops on facilitated communication. They then trained other staff to facilitate. These staff then facilitated the participants, who had been in the program for between five and twelve months at the time of the tests, There is no mention of any speech/language, hand function or literacy assessments being undertaken before or during the program.
"Every effort was made to maintain a typical, comfortable environment ... The facilitator and participant sat at one end of a long table which was divided lengthwise down the middle with a 182.9 cm-long, 73.7 cm-high divider," A researcher sat behind a screen at the other end of the table. Participants were presented with photos of common objects and asked to communicate the name or content of each picture to the facilitator, from whom the photo was concealed.
The authors reported that their findings "provide a compelling demonstration of consistent, generalized and probably continuous influence of the facilitators." They certainly showed that the participants had great difficulty naming items without cues, and that some facilitators gave cues inappropriately.
The researchers were not speech/language pathologists or AAC specialists and (unintentionally) they had set up a test which would certainly reveal any word-finding problems or pragmatic difficulties in the participants and any inadequacies in the facilitators. There was no recognition of the possibility that some participants, faced with a task they cannot do, might actively seek cues, as Jill did (above). There was also no recognition of the training component of FCT, no recognition that there might be a learning curve for both the participants and facilitators, and that a dyad which failed a test one day might be able to pass a similar test (or a different and more appropriate test) in the future if suitable input and opportunities for practice were provided.
There is an implicit presumption in all the validation studies that cueing in always inappropriate. This is not so. Much communication therapy, in all modalities, involves cues. I ask you "What's the capital of Australia?" If you hesitate I say, "kuh", at which point, I hope, you say, "Canberra". The cue enabled you to retrieve an answer you knew; it did not give you the answer. Cueing is a regular part of therapy for individuals with word-finding difficulties. It is only problematic if the parties involved do not realize that cueing is going on, or if cues are provided in inappropriate situations-in situations, that is, involving significant choices where it is important that the choice in uninfluenced. In such situations, as in tests of facilitation, the twin hazards are that the person may be unable to respond due to word-finding problems or may be cued. It might be possible to avoid both of these dangers by providing multiple choice options. Steve Calculator (17) has described examples of validation achieved though administration of the Peabody Picture Vocabulary Test.
The O.D. Heck. study is typical of psychologist-designed studies in that it reduces all of human communication to the ability to tell someone a specific fact the facilitator's don't know. If that skill is not demonstrated, the assumption is made that no other communication is occurring. Many speaking individuals are not able to do this task. They have the advantage that the retain their speech after the fail, and the rest of their communication is not discounted.
The O.D. Heck researchers imposed maximum interference on a vulnerable system. They were effectively saying that if a signal exists at all it should be able to be read in the worst possible circumstances. If it can't be, it either doesn't exist or isn't worth having.
The tendency to reduce human communication to a binary state, "present" or "absent", which can be judged by the administration of one test by one professional or class of professionals, is of particular concern because a negative report typically results in the cessation of communication aid use and communication training, regardless of the duration of the program (18). In conversation with an O.D. Heck researcher I expressed some surprise that their program had produced none of the positive outcomes reported from other FCT programs (19), outcomes such as significant increases in on-task behavior, decreases in aggression, increases in positive social interaction and eye contact and (with a minority of participants) increases in meaningful speech. The researcher's response was that they had seen these effects but they had been omitted from the report because the researchers were at a loss to explain them (and, perhaps, because they were not so easily quantifiable as the naming of pictures). These benefits are hinted at only once; "The social reinforcement and intimacy reached [remember, the participants have autism] ... are hard to give up ... and no replacement activities that are as meaningful are easily identified."
The participants-in the O.D. Heck study may not have as yet "validated' their communication. However, after only five to twelve months involvement in an FCT program they are already reported as having achieved social reinforcement and intimacy, two of the most important goals for which we use communication. Achievement of these goals is far more likely to have a positive effect on their future lives than any amount of picture naming. Only people who have lost the plot could consider searching for 'replacement activities".
A number of formal hearings involving users of facilitated communication have taken place in the U.S. Most have been due-process hearings held to resolve disputes about service provision or the right to education in a mainstreani school, and many of these have produced positive outcomes for the students with SCI involved. The relatively few court proceedings involving witnesses using facilitated communication have been problematical, both in the procedures used and the outcomes.
In New York State in 1992 the New York State Family Court of Onondaga County heard a case of purported abuse involving a child with Down Syndrome and SCI. (20)
On motion of Respondents, a pre-trial hearing was held concerning the admissibility in a fact-finding proceeding under Article 10 of the Family Court Act of certain evidence obtained through a technique known as 'facilitated communication'...
Judge Buck ruled that the evidence could not be admitted unless (a) the use of the method of facilitated communication was supported by expert testimony, and (b) that testimony met the requirements set by Frye v. U.S. (21) for the admissibility of expert testimony - the Frye test. After hearing witnesses on this point the Court ruled that
Taking the record as a whole, the Court concludes that Petitioner has not made a Prima facie case as to the admissibility of testimony based on facilitated communication with a child diagnosed as having Down's syndrome.
The case was dismissed (22)
Judge Buck also said that..
It should be pointed out that these findings do not constitute any judgement on the utility or reliability of facilitated communication.
The Frye test requires that a procedure is generally accepted as reliable by the scientific community before the results of its use can be introduced into evidence. It was first used to evaluate polygraph evidence and was later applied to DNA testing and the use of breathalyzers. Is it, however, appropriate for facilitated communication?
Facilitation is used as a teaching and communication strategy. It is appropriate for some people with a given diagnosis and not for others. Those people for whom it is appropriate exhibit a wide range of communication aptitudes. If just one child with Down Syndrome in a hundred is able to type successfully with facilitation, the question to be asked is surely whether the actual child giving evidence is the exception or the rule, not what statistical probability or professional opinion suggest.
In Australia Frye hearings do not exist. Evidence will be lead and accepted or not accepted by the court - there is no - there is no mechanism for receiving or excluding an entire group of potential witnesses because of the communication strategies they use. The first court case involving facilitated communication in Australia was Anne McDonald's application to the Supreme Court of Victoria for a writ of Habeas Corpus in 1979. As facilitated communication was being used for the first time in only one location it could scarcely have attained general acceptance. The finding centered on the reliability of Anne s communication, not on the potential reliability or unreliability of the communication strategy in general or the appropriateness of its application to members of a specific diagnostic group. If the Frye test had applied, no evidence could have been lead about Anne's own communication or the tests Anne had performed. Rather, her action would have been deferred pending scientific consensus about the appropriateness of a person with athetoid cerebral palsy using facilitated communication. Given the N.Y. decisions it appears she would still be waiting.
Using scientific consensus as the yardstick for assessing new procedures requires the judge only to make a finding of fact as to the existence of such a consensus, not to make a finding of fact about the procedure itself. However, the questions raised by evidence given with facilitation seem more like the kind of questions about the credibility of witnesses that Courts customarily resolve in their day-to-day operations than the type of forensic decision that courts customarily refer to independent professionals. Consensus that communication of this nature is possible will not greatly assist the court in determining whether it has in any given case occurred. It will always be necessary to investigate whether a particular 'speaker' can in fact communicate with a particular facilitator and whether, if that is established, the facilitator did actually receive the particular communication claimed, before looking at the truth of the evidence.
In New York State it has been decided, through Frye, that evidence in a particular case is to be considered on its individual merits only if other evidence in the same mode could be regarded as reliable in other hypothesized future cases. Ironically, despite the fact that Anne McDonald actually performed tests in the Supreme Court of Victoria in later proceedings and is now a college senior, she would be excluded from giving testimony in any court in N.Y. state as I result of the 1992 Frye findings.
It is not necessary to believe that all cases of alleged abuse are well-founded in order to feel that the Frye precedent set in N.Y. may lead to some cases of abuse going unremedied. Other evidence may be available, but while physical evidence may suffice to prove abuse it may not, in the absence of the testimony of the victim, identify a particular abuser. It is also the case that in many jurisdictions, including that of the New York Family Court, physical evidence is only admissible to support a statement; if the statement is disallowed, none of the other evidence can be led. Some reports of abuse have been confirmed by confessions; if it is widely known that the victim's only possible mode of giving evidence is legally null, fewer confessions can be expected.
Despite all the difficulties that have surrounded the introduction of FCT to North America the overall picture is still bright. There are many excellent facilitation training programs operating, and many people with SCI are achieving goals which neither they or their caregivers and teachers would have thought possible two years ago. A wide range of research into various aspects of FCT is under way, in great contrast to Australia, where few academics have taken any interest in FCT and it is virtually impossible to get research funds.
The General Assembly of Virginia took an original approach to FCT, stating "whereas, although trapped by their lack of physical and mental control over bodily direction, many autistic and other such persons have been allowed to converse with others through a method called facilitated communication" and resolving that "the Department of Rehabilitative services ... be requested to study the viability of and prepare a plan for the development and implementation of facilitated communication programs across the Commonwealth. (23)
TASH recognized that provision of alternative communication strategies was only the first step in empowering people with SCI when it passed a resolution mandating the right to communicate at its 1992 conference.
Biklenâs first videotape, I am not autistic on the typewriter featured a pre-schooler, Dougie, cueing up the computer to tell his therapist that her Îwolfâ was really Goofy. Visiting an elementary school in 1992 I saw Dougieâs name on a coat hook and asked after him. His speech has not improved greatly, but he no longer uses facilitation - he writes with a pencil, independently, like the other six-year-olds in his class.
The goal of FCT is to allow people with SCI to communicate as effectively as possible. It is fitting that the last word on facilitated communication should come from one of its users.
Helen Keller could speak but not hear or see. In a speech she described books as 'paper wings'. Daisy Waite, a teenager from Vermont who can see and hear but cannot talk, was asked what 'paper wings' meant to her.
"Paper wings I think are the freedom of speech only in my case the wing is the freedom to facilitate. The paper wing I dream about is the ability to think then express it. I have been the mime too long. I need a verbal response. I am real verbal now.
"The facilitation darn thing - that gives me paper wings. I soar the winds on words that take me higher and higher. As I go I fly the skies to independence; to speak now, no more the mime with only young saving or childish thinking and motions. To fly is the way to live. I had only to exist before.
"I am under the guidance of my flight instructor. Darn glad; I'm not ready to solo, I'm on paper wings till then. I am pleased to soar and see the world. I think of the planes yet invented I am the newest model. I am aerodynamic, yet I really be young to fly; too young to fly alone. Youth is a price. I willingly aviate until I am able to type alone. Then my paper wings will become the pleasing real wings of independence."
Daisy Waite, Vermont, 1992 (24)
1) By definition 'severe communication impairment' refers to severe speech and writing impairments not caused by hearing impairments.
2) Most (71%) individuals with SCI have been labelled as intellectually impaired (Bloomberg & Johnson, 1990)
3) Grove, N. & Walker, M. (1990) The Makaton Vocabulary; Using manual signs and graphic symbols to develop interpersonal communication, Augmentative and Alternative Communication, 1, 15-28
4) Crossley, R. and McDonald, A. (1980) Annie's Coming Out, Melbourne, Penguin
5) Descriptions of these and other examples may be found in Biklen, D. (1993) Communication Unbound, New York, Teachers College Press
6) Biklen, D. (1990), Communication unbound; autism and praxis, Harvard Educational Review, 3, 291-314
7) Biklen received an IEEIR fellowship from the World Rehabilitation Fund and initially reported his findings to the WRF.
8) In Australia there was widespread media coverage of Anne McDonald, who has CP and uses facilitated communication, from 1979 on. Nonetheless I have only heard of one example of an Australian caregiver trying out facilitation with a child with CP as a result of this publicity.
9) Or what is taken for liberty - if an individual has impaired gaze inhibition looking around may not be a matter of choice.
10) Additional indicators are listed in Biklen & Schubert (1991), New words: The communication of students with autism. Remedial and Special Education, 3, 291-314
11) Sometimes researchers will deliberately set up situations in which the possibility of such transmission is increased, but the interaction is still essentially conversational in nature.
12) An influential example of such testing occurred in Australia (Intellectual Disability Review Panel, 1989, An Investigation Into the Validity and reliability of Assisted Communication, Melbourne, Author). Three children with SCI diagnosed as autistic were asked to answer a series of questions while both they and their facilitators wore headphones. Sometimes the facilitator and aid user heard the same questions, sometimes they heard different questions, and sometimes the facilitator heard white noise. Only one child out of three was successful, cv. three out of three successes with conversational validation.
13) By the end of 1991 31% of the students in the DEAL FCT program were able to type short sentences without facilitation. This included some individuals who had failed validation tests involving confrontational naming.
14) Archer, A. (1992) Where is the "Facile" in "Facilitated Communication"?, Communicating Together, 10,4,5
15) Eberlin et al (1992), Paper delivered at Annual Conference of Re-,ion X, AAMR, Albany, N.Y.
Szempruch, J. and Jacobson, J. (1993), Evaluating Facilitated Communications of People with Developmental Disabilities, Research in Developmental Disabilities, (in press)
Wheeler, D., Jacobson, J., Paglier, R., and Schwartz, A. (1993), An Experimental Assessment of Facilitated Communication, Mental Retardation, 31,1,49
16) Wheeler et al (ibid)
17) Calculator, S., and Singer, K (1992), Preliminary Validation of Facilitated Communication, Topics in Language Disorders, 12,5,ix
18) Eberlin et al (loc.cit.) reported that 21 children with autism, SCI and unknown literacy skills failed a typing test after 20 hours of work with untrained facilitators.
19) Hoffman, M., Dunn, K. (1992) Paper delivered at Annual Conference of the Autism Society of America, Albuquerque, New Mexico.
20) In the matter of M.Z., et al, 14 September, 1992, unpublished case.
21) Frye v. U.S., 293 F. 10 13, D.C. Cir, 1923
22) A similar case with an identical result was heard in 1992 in Ulster County; S v. S (unpublished case)
23) House Joint Resolution No. 38, 1992 session
24) Paper Wings was originally published in the New England Newsletter on Facilitated Communication, p. 1
This paper was first published in April, 1993, as a special issue of INTERCHANGE, the journal of IEER (International Exchange of Experts and Information in Rehabilitation) at the University of New Hampshire, and DEAL is grateful for the opportunity to reprint it here.
This site is proudly sponsored by
Vicnet