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Facilitated communication

This information sheet has been written to provide information on a particular intervention/approach and any research connected with it, not as a recommendation. The outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention. An intervention that may help one individual may not be effective for another. It would therefore not be appropriate for The National Autistic Society to recommend any one particular practice or therapy.

What is Facilitated Communication?

Facilitated Communication (FC) began in Australia in the 1970s. Rosemary Crossley, an aide at an institution for people with severe multiple disabilities, encouraged a young woman who had cerebral palsy to communicate by acting as her facilitator (Crossley and MacDonald 1980).

The facilitator normally supports a client's hand, wrist or arm while that person uses a communicator to spell out words, phrases or sentences.

Crossley went on to establish the DEAL Communication Centre in Melbourne in 1986 which aimed to "assist people with no speech or with dysfunctional speech to find alternative means of communication". Use of FC with people with autism is centred on the notion that many of the difficulties faced are due to a movement disorder rather than social or communication deficits. Much of the philosophy of the DEAL centre was based upon the premise that the language skills (as opposed to speech skills) of people with autism and other communication disorders were generally less impaired than previous research had indicated. The assumption is that the problem of communication for people with autism is essentially a difficulty with expression. Interest in FC quickly spread to other countries - in particular the USA, Canada and Denmark and recently it has been used within the UK with some people with autism.

There have been highly publicised claims for its effectiveness. Many are now communicating ... and producing language of such complexity as to challenge commonly held beliefs about the language of people diagnosed as autistic or significantly intellectually impaired (Crossley and Remington-Gurley 1992).

Research into FC

Alongside the enthusiasm there has been significant criticism of the approach. There has been some reluctance by advocates of FC to put it forward for independent evaluation on the basis that such evaluation would be artificial and interfere with the relationship of trust between facilitator and client.

Nevertheless, experimenters have over recent years built up a useful body of research. Howlin (1997) in her review of 45 controlled trials of FC involving over 350 subjects found confirmation of independent communication in only 6% of subjects. In more than 90% of cases the responses were found to be influenced unwittingly by the facilitators rather than the clients.

Bebko, Perry and Bryson (1996) found some evidence of independent communication in nine (of 20) subjects. However, among students who were capable of responding independently, their responses were worse under facilitated conditions than they were unsupported.

Meanwhile in the United States, in an unprecedented move, five major national professional bodies have now adopted a formal position of opposing the acceptance of FC as a valid mode of enhancing expression for people with disabilities. These bodies include The American Association on Mental Retardation, the American Academy of Child & Adolescent Psychiatry and The American Speech-Language-Hearing Association.

The research review on educational interventions commissioned by the Department for Education and Employment (Jordan, Jones and Murray 1998) concluded that it would be hard to justify further research on FC. There has already been a large number of anecdotal and ethnographic case study reports detailing the technique's supposed benefits, followed by an even greater number of controlled scientific studies, all showing that the phenomenon fails to materialise once facilitator effects have been controlled.

Mostert (2001) in his review of studies into FC since 1995 confirms that their conclusions support those of earlier studies that claims are largely unsubstantiated and that its use as an intervention for people with communication impairments should not be recommended.

Alleged abuse

A further concern of Facilitated Communication has been around accusations of abuse. There has been some use of this unproven technique in court cases in the USA. It is suggested that this has only been possible by courts evading their state's test of scientific admissibility (Gorman 1999).

In the first case brought in the UK relying solely on accusations obtained via FC a businessman was cleared of the sexual abuse of his 17-year-old son who has autism, epilepsy and who cannot speak (Rumbelow 2000). Dame Elizabeth Butler-Sloss, President of the High Court Family Division, condemned FC as dangerous and declared that it should not be used by British courts to support or reject allegations of abuse. Gina Green, director of research at the New England Centre of Autism, has previously likened the method to the use of "dowsing sticks and the ouija board".

Contacts

Communication Options, 3 St Peters Street, Stamford, PE9 2PQ; tel: +44 (0)1780 766 135; email: ememug@loneone.net
DEAL Communication Centre Inc., 538 Dandenong Road, Caulfield 3162, Victoria, Australia; Tel: +61 3 9509 6324; fax: +61 3 9509 6321; email: dealadmin@ozemail.com.au website: www.vicnet.net.au/~dealccinc

References

American Academy of Child and Adolescent Psychiatry. Policy statement on facilitated communication, approved by Council 20 October 1993.

Attwood, T. Movement disorders and autism: a rationale for the use of facilitated communication. Communication, 1992, 26(3), pp. 27-29.
Available from the NAS Information Centre

Bebko, J. M. Perry, A. and Bryson, S. Multiple method validation study of facilitated communication: II Individual differences and subgroup results. Journal of Autism and Developmental Disorders, 1996, 26, pp. 19-42.
Available from the NAS Information Centre

Bettison, S. Informal evaluation of Crossleys facilitated communication. Journal of Autism and Developmental Disorders, 1991, 21(4), pp. 561-563.
Available from the NAS Information Centre

Biklen, D. Communication unbound: autism and praxis. Harvard Educational Review, 1990, 60, pp. 291-315.

Biklen, D. Communication unbound: how facilitated communication is challenging traditional views of autism and ability/disability. New York: Teachers College Press, 1993. 0807732214.

Biklen, D. and Schubert, A. New words: the communication of students with autism. Remedial and Special Education, 1991, 12(6), pp. 46-57.

Crossley, R. and McDonald, A. Annie's coming out. New York: Penguin Books, 1980.

Crossley, R. and Remington-Gurley, J. Getting the words out: facilitated communication training. Topics in Language Disorders, 1992, 12, pp. 29-45.

Edelson, S.M. et al. Evaluation of a mechanical hand-support for facilitated communication. Journal of Autism and Developmental Disorders, 1998, 28(2), pp. 153-157.
Available from the NAS Information Centre

Emerson, A. Facilitated communication. Communication Matters, April 1994, pp. 20-23.

Emerson, A. Facilitated communication: a practitioners personal account. Communication, Spring 1996, pp. 16-19.
Available from the NAS Information Centre

Facilitated communication reports generate heated controversy. Autism Research Review International, 1991, 5(1), pp. 1-2.
Available from the NAS Information Centre

Gorman, B.J. Facilitated communication in America: eight years and counting. Skeptic, 1998, 6(3), pp. 64-77.

Gorman, B.J. Facilitated communication: rejected in science, accepted in court a case study and analysis of the use of FC evidence under Frye and Daubert. Behavioral Sciences and the Law, 1999, 17(4), pp. 517-541.

Gould, J. Facilitated communication: an overview. Communication, 1993, 27(2), pp. 9-15.
Available from the NAS Information Centre

Grayson, A. Can the physical support given in facilitated communication interactions help to overcome problems associated with executive function? In: Living and Learning with Autism. Sunderland, Autism Research Unit, 1997, pp. 231-242.
Available from the NAS Information Centre

Green, G. and Shane, H.C. Science, reason and facilitated communication. Journal of the Association for Persons with Severe Handicaps, 1994, 19(3), pp. 151-172.

Happé, F. The autobiographical writings of three Asperger syndrome adults: problems of interpretation and implications for theory In: U. Frith, ed. Autism and Asperger Syndrome, Cambridge: Cambridge University Press, 1991, pp. 207-247.
Available from the NAS Information Centre

Howlin, P. Autism: preparing for adulthood. London: Routledge, 1997. 0415115329, pp. 5-6.
Available from the NAS Information Centre

Howlin, P. Facilitated communication and autism: are the claims for success justified? Communication, 1994, 28(2), pp. 10-12.
Available from the NAS Information Centre

Howlin, P. and Jones, D.P.H. An assessment approach to abuse allegations made through facilitated communication. Child Abuse and Neglect, 1996, 20(2), pp. 103-110.

Jones, D.P.H. Autism, facilitated communication and allegations of child abuse and neglect. Child Abuse and Neglect, 1994, 18(6), pp. 461-493.

Jordan, R., Jones, G. and Murray, D. Educational interventions for children with autism: a literature review of recent and current research. London: Department for Education and Employment, 1998.

Kerrin, R.G. et al. Who's doing the pointing? Investigating facilitated communication in a classroom setting with students with autism. Focus on Autism and other Developmental Disabilities, 1998, 13(2), pp. 73-79.
Available from the NAS Information Centre

Kezuka, E. The role of touch in facilitated communication. Journal of Autism and Developmental Disorders, 1997, 27(5), pp. 571-593.
Available from the NAS Information Centre

Konstantareas, M. M. Allegations of sexual abuse by nonverbal autistic people via facilitated communication: testing of validity. Child Abuse and Neglect, 1998, 22(10), pp. 1027-1041.

Konstantareas, M.M. and Gravelle, G. Facilitated communication: the contribution of physical, emotional and mental support. Autism, 1998, 2(4), pp. 389-414.
Available from the NAS Information Centre

Mostert M.P. Facilitated communication since 1995: a review of published studies. Journal of Autism and Developmental Disorders, 2001, 31(3), pp. 287-313.
Available from the NAS Information Centre

Myles, B et al. Collateral behavioral and social effects of using facilitated communication with individuals with autism. Focus on Autism and Other Developmental Disabilities, 1996, 11(3), pp. 163-169.
Available from the NAS Information Centre

Perry, A. et al. Brief report: degree of facilitator influence in facilitated communication as a function of facilitator characteristics, attitudes and beliefs. Journal of Autism and Developmental Disorders, 1998, 28(1), pp. 87-90.
Available from the NAS Information Centre

Prior, M and Cummins, R. Questions about facilitated communication and autism. Journal of Autism and Developmental Disorders, 1992, 22(3), pp. 331-336
Available from the NAS Information Centre

Richer, J. Facilitated communication: a response by child protection. Child Abuse and Neglect, 1994, 18(6), pp. 531-537.

Rimland, B. Facilitated communication: problems, puzzles and paradoxes: six challenges for researchers. Autism Research Review International, 1991, 5(4), p. 3.
Available from the NAS Information Centre

Rimland, B. Facilitated communication: a light at the end of the tunnel? Autism Research Review International, 1993, 7(3), p. 3.
Available from the NAS Information Centre

Routh, D. K. Facilitated communication as unwitting ventriloquism. Journal of Pediatric Psychology, 1994, 19(6), pp. 673-675.

Rumbelow, H. Autistic son's language aid led to abuse charge. The Times, 13 July 2000, p.9.

Siegel, B. Brief report: assessing allegations of sexual molestation made through facilitated communication. Journal of Autism and Developmental Disorders, 1995, 25(3), pp. 319-326.
Available from the NAS Information Centre

Twachtman-Cullen, D. A passion to believe: autism and the facilitated communication phenomenon. Oxford: Westview Press, 1997. 0813390982

Williams, D. Invited commentary: in the real world. Journal of the Association for Persons with Severe Handicaps, 1994, 19(3), pp. 196-199.

Other resources

There are several FC newsletters to keep people in touch with FC developments and with each other:

New England Newsletter on Facilitated Communication, Community Developmental Services, 50 Grandview Drive, Barre, VT 05640, USA; tel: +1 802 479 2502; fax: +1 802 479 4056; email: HarveyL@wchhs.org

The Facilitated Communication Digest, a quarterly newsletter from Syracuse Universitys FC Institute, 364 Huntington Hall, Syracuse, NY 13244-2340, USA

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Any item shown as available from the NAS Information Centre may be ordered at a cost of £3.00 per article/book chapter, subject to copyright restrictions. Please complete a copyright declaration form and post it with your payment to the NAS Information Centre, 393 City Road, London EC1V 1NG, or fax to +44(0)20 7833 9666.

If you require information on other approaches please contact the Information Centre.

The NAS Information Centre produces fact sheets on a wide variety of topics and can provide customised reference lists in response to individual requests. These lists are extracted from our database which contains over 12,000 books and articles from the autism field. This service is particularly useful for those wanting to research a specific subject thoroughly.

The NAS continually strives to keep abreast of current information and research in the field of autism. However the detail provided in this factsheet should not be seen as a comprehensive review of all the literature on FC, and we cannot guarantee that it includes all the latest research data. Parents and professionals are encouraged to investigate thoroughly all approaches available in order to determine which might be appropriate for any one individual based on his/her needs.

November 2004