Tuesday, October 25, 2011

Old facilitated communication controversy and new iPad "research"

This recent 60 minutes clip about autistic folks using iPads to communicate reminded me of a Frontline clip I used to show about facilitated communication (that link takes you to google video, which makes me a bit nervous b/c I thought google video was going away?).

The Frontline clip presents a dramatic and compelling story about how a "revolutionary technique" can take hold of a group of professionals, and then goes on to show how careful experimentation reveals that what appeared to be "revolutionary" was actually just confirmation bias. I used to show the clip up to the point of the experimental design and then have groups of students design tests to gather evidence about the validity of the facilitated communication technique. Word of warning: the clip involves accusations of sexual abuse and some of the language gets graphic.

The more recent 60 minutes clip is a great feel good story, and it might be interesting to show after the Frontline video. Is there any chance some of the folks working with iPads are falling into the same cognitive "facilitated communication" traps? What are the similarities and differences?

image credit: http://tweetbuzz.us/entry/78160135/www.cbsnews.com/video/watch/?id=7385402n

posted by Rob McEntarffer


london Counselling said...

The improving technology enable new methods that can be used in psychological treatments. However, the most important thing is missing here. Unless there is a relation and connection between the participants I doubt these methods' effectiveness.

Beth Theisen said...

I have a child with autism who recently obtained an iPad. The big difference between FC and using an iPad is that there is no one holding the users hand. My daughter has made considerable gains since she has been using an iPad and everything she does is independent - she answers the questions on her own and is in total control of the device. If the child or adult cannot use the device on their own, then it could become facilitated communication. FC is a method, and has nothing to do with a device being used.

Rob Mc said...

Thanks VERY much for the feedback, Beth. I asked some folks in my district who work with autistic students about the 60 minutes clip and their experience matches yours: the iPad really seems to be a communication device for the students and is completely different from the facilitated communication technique. Thanks very much for the comment!

Rob McEntarffer said...

I recently got a thoughtful email about this issue and I wanted to make sure it got "attached" to this post - if you are interested in reading more about FC, I think this email and the linked article are an important resources! (Thanks Janyce!)

"Hi, I recently saw a post about facilitated communication on your "Teaching High School Psychology" blog. I thought you might be interested in an article I wrote, recently published in the journal Evidence Based Communication Assessment and Intervention. I was the facilitator in the Wheaton case (from the Frontline show "Prisoners of Silence) and decided to write about my experiences with FC after the most recent abuse allegations was aired in January 2012 on ABC's 20/20. I believe the access to the article is still free online (until June). Please feel free to pass along this link to anyone you think might be interested. FC hasn't changed much in 20 years and, in my opinion and experience, it should be stopped. Here's the link to the article: http://www.alphagalileo.org/ViewItem.aspx?ItemId=119398&CultureCode=en"

Link to the original article:

James said...

Mr. McEntarffer:

Excellent question. The use of iPads will open up many opportunities not before imagined. But, there are many pitfalls. One of the most problematical is "prompt dependency," when the teacher give cues unconsciously, as in facilitated communication (FC), and the student learns to respond to them instead of to the real questions or information.

It is not enough to not be holding the child's hand. The exact same set of problems arise when someone is holding the communication device. Anything can signal choices, and create the illusion of genuine communication.

If a person holds the iPad, the cues are just moved. They are not eliminated. Subtle movements of the device (or paper letterboard) can easily signal the choices. Often this involves the aide moving the next letter or choice slightly in the direction of the child's finger, and the child responds with a larger movement in the opposite direction until they meet. This is exactly what seems to be happening in the FC variant Rapid Prompting. In RP, the communication aide is gradually taught to give increasingly subtle signals while the communicator is taught to respond more effectively to them.

But, we also must be concerned about other kinds of signaling.

A parent or aide can breath unconsciously or give another signal when the child moves toward the correct selection. I have seen children sequence through a series of items then stop when the aide reaches out, signaling the expected response is made. This can happen with iPads, or even when children are choosing PECs chips. And, the illusion can be even more subtle (and impressive in its own way). I once watched a parent move his hand around on his torso (I hope unconsciously) as his child mirrored the movements on the keyboard. He was clearly the one composing. She was only the typist.

No matter what the method, it is critical that the authorship be evaluated objectively and independently. As Ms. Boynton points out, you can't feel yourself controlling the output. (That is what over 100 years of research on these unconscious cueing phenomena also shows.) I have seen many smart people fall for the most obviously cued output. Falling for subtle FC is even easier.

James T. Todd, Ph.D.

Janyce said...

The term "Rapid Prompting" was new to me until recently. When I saw it in action, though, on a video, it reminded me of how facilitated communication was being taught in the early 1990's. Even the FC proponents back then warned against holding the letter board or Canon communicator (the technological tool at the time) in the air because of facilitator influence, though obviously the practice has continued. It seems the technology has changed in the twenty years I've been away from it, but the technique has not. Worse still, the proponents of FC (or Rapid Prompting or Supported Typing), seem to be resistant to the idea that even trained facilitators who believe in what they are doing have the capacity to influence the communications without realizing it. I echo Dr. Todd's recommendation to evaluate authorship objectively and independently. From personal experience and in observing others using FC or this new Rapid Prompting, I can attest to the fact that facilitators are much too busy focusing on the communication process during activities meant to be conversational to maintain the constant vigilance required to ensure independent communication 100% of the time. All efforts must be taken to make sure no signaling (conscious or unconscious) is being passed from the facilitator to the disabled person. Despite their intentions not to influence the communications and any guidelines they're trying to follow, facilitators (in my opinion) aren't reliable in providing the objective feedback necessary to determine independence. They're simply too close to the situation to be objective. I also don't think facilitators can reliably test facilitators for the same reason. Testing doesn't have to be complicated, but it does need to be carried out independently and in a way that proves authorship. There are examples from the scientific literature on this subject that demonstrate how this can be done. Safeguards must be put in place so that no person is having someone else do the typing for them. I would think iPads do have a lot to offer in terms of legitimate applications in learning and expressing language...as long as the person using it is truly using it independently. Regards, Janyce

Rob McEntarffer said...

More current references from Janyce! Thanks!

I thought you might be interested in these articles recently or soon to be published in the journal "Evidence Based Communication Assessment and Intervention" (Psychology Press). Regards, Janyce

Facilitated Communication: What Harm It Can Do – Confessions of a Former Facilitator (Boynton) http://www.tandfonline.com/doi/abs/10.1080/17489539.2012.674680

An Experiential Account of Facilitated Communication (Sigafoos & Schlosser) – Editorial
(link not yet available)

Facilitated communication: The empirical imperative to prevent further professional malpractice (Mostert)

Understanding facilitated communication: Lessons from a former facilitator—Comments on Boynton, 2012 (von Tetzchner)

The moral obligation to be empirical: Comments on Boynton's “Facilitated Communication-what harm can it do: Confessions of a former facilitator”(Todd)

The Dark Legacy of FC (Palfreman)