The Controversy Over Facilitated Communication
Method of Non-Verbal "Speech" May Be of Dubious Efficacy
In late November of 2009, the media was abuzz with the story of a Belgian man, Rom Houben, who had evidently been in a coma for 23 years, but was later found to have been conscious the entire time. Initial details were sketchy, with some reports claiming that recent PET scans of the man's brain had shown normal activity; other articles reported that his consciousness was established by his alleged ability to answer questions by moving his eyes or wiggling his big toe. Soon enough, a video emerged on YouTube, showing the man in his bed, being tended to by a woman who held his hand over a keyboard, supposedly helping him to type words. This video caused some to suspect that the man might not be conscious after all, for this particular method of aiding a disabled person in the use of a keypad is known as facilitated communication (FC), and has been found in several studies to be ineffective, if not completely baseless.
Facilitated Communication and Autism
The technique of facilitated communication was developed in Australia, and in 1990 was brought to the United States by Dr. Douglas Bicklen, a professor of special education at Syracuse University. The simple method — which entailed a trained "facilitator" holding a patient's hand over a keyboard and helping him type — was originally developed for use with cerebral palsy patients or other people whose disabilities interfered with their muscular control. But Dr. Bicklen believed the technique might be effective with autistics who were non-verbal or otherwise unable to communicate.
Sure enough, when Bicklen assigned facilitators to aid autistic children, the method appeared to work spectacularly; soon the children were typing a blue streak, producing stories and poems, proclaiming written love for relatives, and passing high school and college courses with ease. Parents were overjoyed that their previously unresponsive children could now share their rich inner lives; shortly afterward, public schools began hiring facilitators and developing their own FC programs. The technique introduced by Dr. Bicklen seemed to be a tremendous success.
Initial Doubts and Claims of Sexual Abuse
From very early on, however, doubters began pointing out inconsistencies in these apparently miraculous therapies, as discussed in a Skeptic article written by Lawrence Norton. For one thing, most of the autistic children seemed to be producing impeccable spelling, properly constructed sentences and grammatically correct essays, even though some of them had never learned to read or write. Secondly, many of the monitored children seemed to be looking at the ceiling or elsewhere during the sessions, rendering them incapable of seeing the keyboard they were supposedly typing on. Added to these doubts was the fact that the children were found to be unable to perform the technique with parents who attempted to help them type when the children were away from their facilitators. Skeptics began to suspect that it was the facilitators, and not the children, who were communicating through FC.
Criticisms became more numerous when FC began to reveal a dark side. As Michael Shermer mentions briefly in his book Why People Believe Weird Things, some autistic children, with the aid of their facilitators, were accusing parents or other caregivers of sexual abuse. Some children were even removed from their homes by welfare agencies as a result of these allegations, and some parents were also charged. In the midst of this unfortunate situation, a few scholars decided to test the efficacy of facilitated communication.
Tests of FC Fail to Produce Positive Results
The first formal test was undertaken by speech pathologist Dr. Howard Shane. He showed an autistic girl and her facilitator a series of pictures which the girl was then asked to identify using FC. When the girl and the facilitator were shown the same picture, the typed message was always correct, but when they were shown different pictures, the message only corresponded to the picture the facilitator had seen. A similar test in 1993 of 21 autistic schoolchildren produced comparable results, as did a 1994 study of 19 disabled adults. Eighteen more children were tested in 1995, with experimenters asking the subjects to answer questions through FC; results showed that correct answers were only produced when the facilitators knew the desired answers. The results of these and several other studies throughout the 1990s led many experts to the conclusion that facilitated communication was little more than the deliberate or unconscious actions of the facilitator masquerading as the thoughts and wishes of the patient. Studies were so definitive that in 1994 the American Psychological Association cast aspersions on the practice, calling it "controversial and unproved...with no scientifically demonstrated support for its efficacy."
Despite its lack of scientific respectability, FC is still in wide use among parents and caregivers of autistic or developmentally disabled patients. As in the case of the Belgian man and the 23-year coma, the question of whether there is actual communication taking place or just the wishful thinking of the caregivers may never be fully resolved.
Sources:
Norton, Lawrence. "Facilitated Communication and the Power of Belief." Skeptic. Vol 12 No. 4. 2006: 14-15.
Shermer, Michael (1997). Why People Believe Weird Things: Pseudoscience, Superstition, and Other Confusions of Our Time. Freeman. ISBN 0716730901.
“Doubting a ‘Locked-In’ Man’s Words.” Available at: http://thelede.blogs.nytimes.com/2009/11/25/doubting-a-medical-miracle/ Nov 25 2009.
“Mystery as coma survivor Rom Houben finds voice at his fingertips.” Available at: http://www.timesonline.co.uk/tol/life_and_style/health/article6930608.ece Nov 25 2009.
“Facilitated Communication: Courts say ‘No’.” Available at: http://www.srmhp.org/archives/facilitated-communication.html
Woman With Autistic Boy
|
What do you think about this article?
More in Health & Wellness
Latest Articles