Congratulations to Massachusetts for its new Guidelines for the Preparation of Teachers of [Students with] Moderate and Severe Disabilities: Instruction on the appropriate use of augmentative and alternative communication and other assistive technologies, December 2011. Supporting effective communication is a critically important step in supporting self-determination.
Notable among the guidelines is the inclusion of information on Facilitated Communication Training (Section II Program and Course Design, 2d). Although I have heard two AAC supporters question the inclusion of Facilitated Communication training, due to its having been considered a controversial AAC method, I am glad to see it included in the training guidelines, and I consider its inclusion highly justified. For anyone who has questions about this, I will provide some information and updates to clarify the issue. I will also provide some links for additional reading. This is a complex issue which is sometimes misunderstood and misrepresented. The best approach to it is to understand the complexity.
Support from National Advocacy Organizations
Two national advocacy organizations have had position statements that support Facilitated Communication Training for several years: TASH, Autism National Committee (AutCom). Although it has not issued a statement in support of FC training, the AAIDD (American Association on Intellectual and Developmental Disability) has removed from its website an old position statement recommending caution in its use. In light of the demonstrated progress that has been made by many people who use FC to communicate, other organizations are considering writing supportive statements in the coming year.
In 2011, a landmark documentary film about two men with autism who communicate by typing was released to critical acclaim: Wretches and Jabberers. In the film, two men with autism travel around the world in their quest to change the world’s perspective on disability and people who have limited speech. Both men learned to communicate with fluent natural language through typing with support, using methods of facilitated communication training. The film was selected by the Autism Society as its featured film for Autism Awareness Month and was screened in many locations around the US during April 2011 and after. The two stars and their facilitators delivered the keynote at the Autism Society’s national conference in 2011 and have made numerous keynote presentations, including one at the Arc of Virginia 2011 Annual Conference in Virginia Beach. Both the Autism Society and the Arc have been highly supportive of the film, its stars, and its message. The Autism Society lists Facilitated Communication as a Treatment Option in its brochure Next Steps: A Guide for Families New to Autism.
Controversy and Discussion
Although the research results have been varied relating to FC, the review and opinion articles which claim that FC has been disproven or “debunked” actually overstate the research results. They fail to acknowledge or take into account the research studies in which people have been able to communicate their own messages when their facilitators did not know the content of what they wished to communicate. Interestingly, the studies have not all asked the same research question. Some have sought to know whether influence can happen, and other studies have sought to find out if people can communicate their own thoughts and under what conditions. Studies have found that influence can happen, and studies have also shown that people using FC have been able to communicate their own messages unknown to the facilitator. Bob Rubin addresses the research quite well in his presentation linked below on the ICI website.
The FC Controversy: What is it? Why is there a controversy? by Bob Rubin, Ph.D. http://soe.syr.edu/media/documents/2010/7/Why_the_FC_Controversy.pdf
The information at the following link includes basics about the method of facilitated communication training and about research, with references for research studies on all sides of the issue:
A related article on supported typing and authorship at the following link provides additional helpful information:
Best Practices in Facilitated Communication Training
Although there has been controversy about the method of facilitated communication training, it is important to take a closer look to understand what is FC and what is not FC. In some cases reported in the media and research literature, what has been called FC has been far from the best practice standards which have been developed for FC training. Here is a link to a document listing the elements of Best Practices in Facilitated Communication Training: http://soe.syr.edu/media/documents/2010/6/FUNDAMENTAL_PRINCIPLES_AND_BEST_PRACTICES.pdf Including in teacher training some information about these principles and best practices should be of value, because teachers need to know about the method, to recognize good technique, and to understand the many environmental and interactional variables that can be supportive or detrimental to communication success. They need to know that the goal is independent communication and that this may be a slow and long-term process which may be achieved first through independent yes/no or multiple choice responses before independent open communication is achieved. They also need to know that while working on more complex communication, one also seeks to help the person develop some type of reliable independent communication, such as independently indicating YES or NO or selecting a response from an array of choices. In addition, they need to understand about communication partner skills, movement difficulties and sensory issues, which can have a significant effect on communication.
Increasing Reports of Success
There is an increasing number of people who have used this training successfully beginning in the early 1990s to gain verifiable, reliable independent communication. Many have made notable personal progress in gaining better control of their behaviors and conversational abilities. They have benefited from exposure to print-rich environments and from literacy instruction, which is often not provided to all students who use or need access to AAC, as we know from the many battles of which we hear between parents and schools. A significant number have graduated from high school and college and pursued advanced degrees. For them, the controversy is over, as Beukelman and Mirenda noted in their AAC textbook.
Last Resort Method
The method of facilitated communication training is not a perfect method and is typically a method of last resort to get to more effective, fluent communication. Sometimes it is used in an effort to get any reliable communication, after other methods such as modeling and the use of PECS and sign language and other methods have been tried for years unsuccessfully. FC training can certainly be done poorly, as can any method. In many of the early studies, the training and experience of the facilitators was very limited and was insufficient to teach them strategies for minimizing the likelihood of influence and for teaching the typers to indicate in some way that they were being influenced and not communicating their own messages. Many professionals are waiting for more large-scale quantitative clinical trial research studies with control groups to be conducted so that they might be able to predict what percentage of people will benefit before they will recommend it. Meanwhile, the number of children and adults who are having verifiable success is growing, as their families learn the method and document the specific support that is helpful to their family member and their evidence of independent communication.
FC training is not for everyone, but it has been a method that has helped some people. As with any AAC method, success takes a dedicated team that presumes competence and intellect, works together and learns together how to support the individual using the best techniques, works toward literacy and independent thought and effective fluent communication, tries a variety of methods, and never gives up on the person.
My Perspective
I am a facilitated communication trainer (having completed the introductory FC training and the training of trainers seminar) with an M.Ed. in special education with a specialization in severe and profound disabilities. I learned the method in the early 1990s and have seen it work with many people but not with everyone with whom it has been tried. I have followed the research, controversy, successes and failures, progress and setbacks. People with whom I have seen FCT work have typically been exposed to print-rich environments and have had the opportunity to gain literacy skills. I have not witnessed spontaneous immediate poetry-writing, perfect spelling, or immediate fluent communication. The months and years of hard work that may precede the communication of fluent natural language are seldom documented in news reports. The adults with whom I have worked have typically taken weeks or months to show signs that the method might be one that could potentially be helpful to them—and they have had limited previous success or no success with every other method tried, such as signing, PECS (Picture Exchange Communication System), communication boards, and so forth. They may have been presumed to have limited understanding and may have had labels of significant intellectual disability, based on their poor performance on tests of intelligence which relied on their impulsive movement, limited pointing skills and impaired motor planning.
As we know, without reliable pointing or another way to demonstrate understanding, people sometimes assume the individual has limited cognitive ability and limited learning potential. I see Massachusetts’ move to train teachers about AAC in all its forms and to teach them about how to support people who use AAC as a huge step forward. Many people with speech impairments still wait in silence for effective communication. Their progress in improving their communication will depend on the communication supports provided by parents, friends, and professionals in schools and other services. Giving teachers the skills they need to support students who use AAC or who need access to AAC is a great start.
Congratulations to Massachusetts and to the students who will benefit from having teachers who know more about augmentative and alternative communication and other assistive technologies!