Thursday, 27 November 2014

FC is a technique that has no validity

FC, by the way, refers to Facilitated Communication, a controversial technique which as the name suggests relies on a facilitator to support "the hand or arm of a communicatively impaired individual while using a keyboard or other devices with the aim of helping the individual to point and thereby to communicate." The quote for the title of this post comes from the paper by Ralf Schlosser and colleagues [1] who following systematic review, found "unequivocal evidence for facilitator control" and that "messages generated through FC are authored by the facilitators rather than the individuals with disabilities."
It's funny how sometimes the people we remember
the least make the greatest impression on us.

I wouldn't normally be minded to talk about FC if it wasn't something (a) which has appeared alongside the word 'autism' down the years and (b) had not cropped up in various conferences I'd attended, specifically after having watched people such as Dr Andy Grayson talk about the great authorship debate with regards to FC and autism as per some of his publications in this area [2]. I'm by no means an expert on FC and autism and certainly am voicing no opinion beyond that of the peer-reviewed evidence on its usefulness or not.

What does strike me about this area though is the quite large weight of evidence coming down on 'facilitator control' as forming the lion's share of authorship in FC. I remember the paper from Edelson and colleagues [3] (including the late Bernie Rimland on the authorship team) who, quite ingeniously, talked about evaluating a "specially designed hand-support device" as an aid in the "transition from facilitated communication (FC) to independent typing" with autism in mind. They concluded: "Postassessment measures did not reveal any evidence of independent communication with or without the device." Even the American Academy of Pediatrics (AAP) has an opinion on FC with autism in mind [4]: do not use "except within research protocols".

On the basis of this and accounts of where FC can go so terribly wrong, I'd be inclined to follow the recommendations of the Schlosser paper. Even in these times of phones and tablets potentially making FC a whole lot easier, 'consumer beware' is perhaps an appropriate phrase to be derived from the collected research literature in this area...

Music to close: Empire State of Mind.


[1] Schlosser RW. et al. Facilitated Communication and Authorship: A Systematic Review. Augment Altern Commun. 2014 Nov 11:1-10.

[2] Grayson A. et al. Hidden communicative competence: Case study evidence using eye-tracking and video analysis. Autism. 2012; 16: 75-86.

[3] Edelson SM. et al. Evaluation of a mechanical hand-support for facilitated communication. J Autism Dev Disord. 1998 Apr;28(2):153-7.

[4] Committee on Children With Disabilities. Auditory integration training and facilitated communication for autism. American Academy of Pediatrics. Committee on Children with Disabilities. Pediatrics. 1998 Aug;102(2 Pt 1):431-3.

---------- Schlosser RW, Balandin S, Hemsley B, Iacono T, Probst P, & von Tetzchner S (2014). Facilitated Communication and Authorship: A Systematic Review. Augmentative and alternative communication (Baltimore, Md. : 1985), 1-10 PMID: 25384895