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Facilitated communication (FC) is a highly contentious form of alternative and augmentative communication in which a facilitator helps hold a disabled person's hand while the disabled person guides their finger to letters on a screen, spelling what they want to say.

Facilitated communication remains a controversial practice, with research both proving and disproving its efficacy. No proper scientific source has established that it actually works.

The practice of FC has been associated with various deaths. In 1993, Janice Boynton, a facilitator, claimed through FC that the father of Betsy Wheaton, a 16 year old autistic girl, was sexually abusing her. The claims were found to be false in court. Some years later, Betsy’s brother committed suicide after killing his wife; he was never the same after the family’s temporary breakup, Donvan and Zucker report.[1]

History

FC became a trend in the US and Canada during the early 1990s. Its advocates argued that many autistic and intellectually disabled people were more intelligent than others realized, and that they simply didn't have a way to communication.[2]

Questions of validity

Early concerns

The process fell out of favor as researchers began to notice that in some cases, the facilitator was the only one paying attention to the screen. When the facilitator did not know what the question was, the disabled child would suddenly be unable to produce an answer.[2]

In 1994, the American Psychological Association declared that there was "no scientifically demonstrated support for its efficacy."[2]

Some parents clung to FC because it allowed wishful thinking that their child was able to communicate with them.

Success if done well

Both peer-reviewed and anecdotal evidence suggests that FC can work in some cases.[3][4][5]

Emma Zurcher Long began typing with facilitated communication (arm support or hand-over-hand), and she gradually transitioned to typing completely independently.[6] Amy Sequenzia began FC at age eight and reported that it "changed everything," allowing her to tell her parents her desires and fears.[7]

However, in some cases, the facilitator can influence or change the disabled typist's message. Ariane Zurcher notes one case in which a well-meaning facilitator led a child to allege sexual abuse, only for a closer investigation to show that the child had not authored the messages (the facilitator had).[8] A poorly-trained facilitator might try to guide the hand, or not provide proper support.[9]

This suggests that FC can work if the facilitator is well-trained.

"I think facilitators and users must always observe the best practices," Sequenzia writes. "This is a guide to make sure the user is not being influenced by the facilitator and that the amount of support is the right one."[7]

Potential for invalidation

The backlash against FC has caused some negative consequences for the people who are able to use it effectively. Amy Sequenzia gives one such example:

"When I saw a speech therapist during a process to get a better communication device, she kept showing me pictures and asked me to point to “apple” and “dog”. I was 25 years old! When I reached out to my support person and indicated that I wanted to type, the therapist said I had to work with pictures first. I typed anyway and said I was an adult. The therapist said I wasn’t typing, my facilitator was."[10]

It is important that facilitators be very well-trained and ethical, so that they do not speak for the disabled person, and so that disabled people are believed when they speak for themselves.

Further reading

References

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