Facilitated Communication

What is facilitated communication?

To facilitate is to make easier. In facilitated communication the task of using a communication aid is made easier for a person with a severe communication impairment. The degree of facilitation needed varies from person to person, ranging from an encouraging hand on the shoulder to boost confidence, to full support and shaping of a student's hand to enable isolation and extension of an index finger for pointing.

Facilitation may be most useful for people with severe communication impairments who walk but cannot sign or write. They need to use small, easily portable communication aids with their hands. Such aids display a set of choices - pictures, words or letters - and the user makes selections from these choices, reducing the demands on fine motor skills, motor planning and memory. Unfortunately, many potential users do not have the pointing or selection skills necessary to use such communication aids effectively.

Facilitated pointing can provide a temporary remedy for the hand function impairments of some of these people and may result in a permanent improvement in hand function when used as part of a structured teaching program.

Facilitated Communication: a non-speech conversation between 2 young men with autism. Doron makes a joke.

What is facilitated communication training?

Facilitated communication training is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (facilitator) helps the communication aid user overcome neuro-motor problems such as impulsivity and poor eye/hand co-ordination and develop effective pointing skills.

The immediate aim of facilitated communication training is to allow the aid user to make choices and to communicate in a way that has been impossible previously. Practice using a communication aid such as a picture board, speech synthesizer, or keyboard in a functional manner is encouraged, to increase the user's physical skills and self-confidence and reduce dependency. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.

Who can be helped by facilitated communication training?

Use of facilitated communication is not restricted to any specific age or diagnostic group. It has been used successfully by people with diagnoses including autism, down syndrome, intellectual disability, cerebral palsy and acquired brain damage. For facilitated communication training to be considered as an option for an individual they will:
- have little or no functional speech
- not currently have a fluent alternative communication strategy
- not show the potential to acquire manual signing or handwriting skills easily
- have difficulty with the clear, unambiguous selection of nominated items from communication displays
- not be able to use other direct or indirect access options such as headpointers or scanning systems (perhaps for practical reasons, such as the unsuitability of these options for individuals who walk).

What does a facilitated communication training program include?

Once it has been decided that an individual is a candidate for facilitated communication training it is then necessary to:
- ascertain the nature of the problem(s) which are currently preventing successful communication aid access
- select appropriate remedial strategies, including facilitation strategies if needed
- ascertain what representational systems (concrete objects, pictures, pictographs, written words, letters) are currently meaningful to the potential user
- enable the individual with severe communication impairments to use the most empowering of the representational systems and selection strategies currently available to him/her by obtaining/making appropriate communication aids and teaching those in the individual's environment how the aids are used.

A non-speech conversation: John replies.

The individual with severe communication impairments can now practice using a communication aid with facilitation. This is just the start of the training program. Further teaching and assessment in areas such as literacy, hand function, and pragmatic interactive skills will be required.

If the person with severe communication impairments shows the ability to spell at the initial assessment further assessment and refinement of literacy skills is desirable. If the person does not show usable spelling skills then involvement in a literacy program is desirable. Spelling is the most empowering communication strategy for people who cannot speak or sign fluently, and every effort should be made to develop literacy skills in such people. Infants and individuals for whom literacy acquisition is problematical need to be taught as large a vocabulary of pictures and symbols as possible.

Given that the individual is using facilitation because of problems with hand use, regular hand function assessments, which may result in the prescription of exercise routines or splints, are important.

Whatever the representational strategy used, all communication aid users need to be taught acceptable attention-getting strategies and other pragmatic skills, such as how to position themselves in relation to people they are communicating with.

Multiple communication partners should be trained in order to avoid dependency on any one facilitator. The amount of facilitation provided requires regular review with the aim of reducing it as quickly as possible.

What benefits does facilitated communication training offer?

Communication changes the lives of people with disabilities and their families and friends.

Facilitated communication training has enabled some people without functional communication to take charge of their lives, make their wishes known for the first time, and join the life of their communities. Parents have been enabled to communicate with their children. Children who have had only restricted education, or no education at all, have gone into regular classes; some have completed high school and gone on to university. For some people with challenging behaviours frustration has been relieved and behaviour has improved.

Facilitation is controversial

Facilitated communication has been criticised by some professionals as an unproved technique that is open to abuse and can lead to words being put in the mouth of a person with a disability. The issue is discussed in Flying High on Paper Wings, by Rosemary Crossley, and in The Frontline Debate.

Other Facilitated Communication Material

For more details on the debate and a list of publications, go to the home page of the Facilitated Communication Institute, Syracuse, New York. For other good American links try the Vermont Facilitated Communication Network and Facilitated Communication in Maine - an update. For more discussion of facilitated communication training and the law, go to "Access to Justice for People with Severe Communication Impairment" by Joan Dwyer, republished from The Australian Journal of Administrative Law.

Books on Facilitated Communication

If you need further information on methods of facilitated communication training, a simple outline is given in
Crossley, R., 1994, Facilitated Communication Training, Teachers College Press, New York, $15.95
The Contents page, the Introduction and Chapter Two , and some exercises from the book are available on-line. We are grateful to Teachers College Press for permission to republish this material on the Web.

Rosemary Crossley has also published a book detailing her experiences with people with communication impairment :
Speechless, 1997, Dutton, New York, 23.95.
A section from the book is posted here. We are grateful to Dutton for their agreement to this republication.

For those who with to pursue the issue still further, an extensive bibliography is also available. You can also find a historical overview in Flying High on Paper Wings .

Facilitated communication training users tell their stories Severe Communication Impairment Augmentative and Alternative Communication Entry Point