Facilitated Communication and Autsim

I first saw facilitated communication used with a person with autism in the early ’90s at a conference for those who worked with people with developmental disabilities. A young man with autism sat before a small typewriter while another man sat beside him with his hand under the young man’s forearm. The facilitator then read to the audience what the young man had typed in answer to questions asked by the audience. I was amazed. Here was a man who had never spoken a word suddenly lucid, insightful, and very bright.

It was explained that this was facilitated communication and that it was especially helpful to people with autism. The facilitator placed a hand on the client’s hand, arm, upper arm, or shoulder and the person was able to type words and sentences. Over time this support would be faded back until at least some people could type independently. Some people were much more fluent than others were, but all seemed to benefit. It appeared to me that people locked in silence suddenly had a voice.

People with autism, it was explained, pick up the words and letters from the world around them and already know how to read and write so they are able to use facilitated communication immediately. At first they may only be able to answer yes and no questions but as time goes by they get more proficient.

In the early 90’s facilitated communication for people with autism spread like a wildfire. Staff and families were deeply moved to think that behind the silence was a person with normal to superior intelligence who just need a way to make her voice heard.

Facilitated communication began in the 1970’s by Rosemary Crossly who first used it with a woman with cerebral palsy. Its use then gradually spread to others with no speech. In the late 1980’s Doug Biklin of Syracuse University brought facilitated communication to the United States and Syracuse began training people to practice facilitated communication. It seemed to be especially effective with people with autism and it was centered on the notion that they did not have a communication disorder, but rather, a movement disorder which resulted in difficulty with expressive language.

As the practice of facilitated communication spread so did reports of sexual abuse. People with autism seemed to be reporting sexual abuse, especially by staff or family, in huge numbers and many people were investigated and some were arrested and charged.

All along, there were people who were skeptical about facilitated communication, positing that it worked much like a Oji board.
Studies began which showed that if the facilitator could not see what the client could see, then no accurate communication came forth. In other words, a person with autism might be shown a picture of a ball and asked what he was seeing. If the facilitator could not see the picture, she was unable to assist the person to come up with an accurate answer. Proponents of facilitated communication argued that this occurred because the tests were done in such an artificial setting that the person being tested wasn’t comfortable.

However, testing continued in more natural settings and facilitated communication continued to fail rigorous testing. Howlin in 1997 found that only 6% of subjects actually showed independent communication. Bebko, Perry, and Bryson, (1996) found some evidence of independent communication but also found that those who could type on their own did better doing this than they did with a facilitator.

Several groups eventually opposed facilitated communication as a valid method of communication for those with autism. These include the professional groups for psychologists and psychiatrists as well as the American Association on Mental Retardation, and the American Speech-Language-Hearing Association.

Many people now feel that facilitated communication does have a limited use for a small number of people with autism. But all the early hope does not seem to be born out.