Wednesday, March 13, 2024

Life lessons from programming

  1. Your instructions must be crystal clear, not omit any steps, and anticipate all possible scenarios.
  2. If something goes awry, there’s always a logical explanation.
  3. If something goes awry, it’s your fault, not that of The Cosmos.
  4. You are not the victim of an irrational universe.
  5. Instead, you are complicit in much of the irrationality that most directly affects you.

I was reminded of these lessons last week when creating a new username and password facility for SentenceWeaver: a tricky endeavor as I didn’t want to undermine the older first-and-last-name-based logins that my current users are using. The trickiness was exacerbated by the fact that there was some zombie code hiding in one of my files–entirely my fault, of course.

Wednesday, March 6, 2024

Illusions of literacy in nonspeaking autistic people: a response to Jaswal et al. 2024

 (Cross-posted at FacilitatedCommunication.org).

Do minimally-speaking autistic individuals have literacy skills?

You might assess this by seeing if such individuals can associate word labels with objects—placing the “dog” label, say, on a picture of a dog, and the “cup” label on the picture of a cup. You might assess this by seeing if the person can independently write or type out word labels of their own for the dog and the cup. You might assess this by presenting the person with a note that says, say, “Do you want to watch a video or go outside?” and seeing if the person, for example, responds by fetching a video-playing iPad. That note could be written on paper, but it could be typed out on the overwhelming majority of AAC devices that, contrary to what the pro-FC sector tells you, include keyboards and regularly expose users to printed word labels.

But why use such direct, straightforward literacy probes when you can instead deploy novel equipment and fancy statistics to generate much more indirect and highly indeterminate results? After all, that’s precisely what Vikram Jaswal did in his recent attempt (Jaswal et al., 2020) to find support for the variant of FC known as Spelling to Communicate (S2C, see Beals, 2021 for a critique of this highly flawed study).

This time around, in a study that has just come out (Jaswal, Lampi, and Stockwell, 2024), Jaswal sets out to explore the literacy skills of minimally-speaking S2C users—which, if they are found to exist in sufficient quantities, might convince some more people that S2C is valid. (In fact, the only procedures that would definitively test the validity of S2C, should anyone ever agree to participate in them, are a series of controlled message-passing tests).

In what the authors tout multiple times as a pre-registered study, they created an iPad game with arrays of symbols that flash one at a time in different sequences. Participants were measured on how quickly they responded to the flashing symbols by tapping on them. Some symbol arrays were alphabetic symbols (letters) that just happened to precisely replicate the letter arrangements of the letterboards used in S2C. Others were arrangements of symbols that look nothing like letters:

(From Jaswal et al., 2024)

In one condition, the Sentences Condition, the letters on the letter array flashed in sequences that spelled short sentences. In this condition the experimenter gave the participant an oral prompt about the given sentence, saying it twice, as in this example: “This time, the letters will flash in a sequence that spells, ‘I should water the backyard today. I should water the backyard today.’”

In the other conditions, no sentence prompt was provided. In the “Matched Symbol Sequences” condition, the symbols flashed in a position sequence that matched the position sequence of the flashing letters in the Sentences Condition. In the “Reverse Letter Sequences” and “Reverse Symbol Sequences,” the flashing letters and flashing symbols followed the flashing letters (or the positions of the flashing letters) of the Sentence Condition sentences in reverse order. For instance, in the case of “I should water the backyard today,” the “Reverse Letter Sequences” followed the sequence “yadotdraykcabehtretawdluohsi.”

Measuring the “latency,” or the time it took a participant to go from one flashing letter to the next, Jaswal et al. report the following findings:

Latency is, on average, lower (by several tens of milliseconds) for the Sentences Condition than for the other conditions.

In the Sentences Condition, but not in the Reverse Letter Sequences condition, participants tapped flashing two-letter sequences that are relatively common in English spelling (e.g., “he”) faster than they tapped flashing two-letter sequences that are relatively less common (e.g., “hs”).

In the Sentences Condition, participants showed sensitivity to words and word boundaries: they were slower to tap on the first flashing letter of the word than on the subsequent flashing letters of the word.

All of these behaviors, Jaswal et al. argue, mimic the behavior of literate individuals when they type. Just how closely, however, remains unexplored, as the study reported no comparisons on the flashing letter/symbol tasks between these participants and a comparison group whose literacy was beyond dispute.

But even if these patterns of relative tapping speed on flashing letters/symbols mimic those of people whose literacy is beyond dispute, is this enough to conclude that the autistic participants are literate? Does it mean, say, that they understand written commands to “water the backyard”?

In fact, the difference between

  • (a)

    • tapping the sequence “Ishouldwaterthebackyardtoday,” guided entirely by flashing letters

    • tapping that flashing sequence faster than both the flashing sequence “yadotdraykcabehtretawdluohsi” and flashing sequences of symbols that look nothing like letters, and

    • pausing slightly, while tapping the flashing sequence “Ishouldwaterthebackyardtoday,” between the flashing “I” and the flashing “s,” the flashing “d” and the flashing “w,” the flashing “r,” and the flashing “t,” the flashing “e” and the flashing “b,” and the flashing “d” and the flashing “y”

and

  • (b)

    • knowing what the printed words “I,” “should,” “water,” “the,” “backyard,” and “today” actually mean

Is quite vast.

Jaswal et al. acknowledge the multiple years of experience that most of their participants have had, via S2C, in pointing to sequences of word-spelling letters on held-up letterboards (two participants had between one and two years of experience; the remaining 29 had at least two). And they acknowledge that these experiences could have taught the participants statistical regularities about letter sequences and word boundaries that could explain these results. But they argue that this explanation is ruled out by the fact that the participants (1) weren’t faster with common, flashing two-letter sequences in Reverse Letter Sequences condition (where the letters didn’t spell words), and (2) weren’t consistently faster at tapping flashing letter sequences for more common words than for less common words.

There are major problems with these lines of reasoning, however. In the Reverse Letter Sequences, the sequences so obviously violated English spelling conventions that anyone who has grown accustomed to those spelling conventions—for example by being subjected to years of S2C—will quickly recognize that all bets are off. All of the sequences, that is, contained sub-sequences that are impossible to parse into words:

  • ohy, ehtr, dluohsi, afkaer, ofmaer, ahsdikeht, ohya, ehtno, tsti, sg, odtso, nahtre, ruo, tuo

If they had wanted to, Jaswal et al. could have easily avoided this confound by scrambling the letters in ways that didn’t result in such unparsable sequence. For example, instead of

  • yadotdraykcabehtretawdluohsi

they could have had

  • kaydotdrackabethawdlerthisou

Second, Jaswal et al. assume that what determines how quickly a flashing letter sequence is tapped out is how common the corresponding word is. But, as they themselves propose elsewhere, the issue is predictability: how predictable is the next letter based on what came before? Plenty of common words offer little predictability. Consider the words “it,” “had,” and “way,” which the authors found had high average latency-per-letter (slower typing). With “it,” common though it is, many letters could follow the “i,” and after the “t” the word is over. The same goes for “had” and “way.” It’s longer words with more predictable patterns, even if they’re less common, that should permit lower average latency-per-latter (faster typing). Consider the three words in Jaswal et al.’s sample that show the most extreme combination of lower-than-average commonality (relative to the other words) and lower-than-average latency-per-letter: “walking,” “raining,” and “outside”. By the time you get as far as “walki,” “raini,” and “outs,” the final letters are fully predictable (and, indeed, readily outputted by autofill functions).

(From Jaswal et al. 2024).

But Jaswal et al. propose that the patterns of latency observed in the Sentence Condition and not in the other conditions are evidence, not of a rote, statistical learning of letter patterns, acquired during years of S2C-based prompting, but instead of “motivated, literate participant[s]” who are able to “convert the sentence the experimenter spoke aloud into its written form.”

Of course, if Jaswal et al. had wanted to actually test this hypothesis, they could have included a comparison condition in which the experimenter refrained from reading the sentence out loud.

But this might have put a dent in their grandiose conclusions:

About half of the participants showed the signature pattern consistent with literacy; those who did not show the pattern may also know spelling conventions but be unable to demonstrate their knowledge on our task, which required sustained attention and speeded responses to over 550 targets. Regardless, our findings suggest that at least five times more participants have foundational literacy skills than would be expected from professional estimates based on nonspeaking people’s overt behavior. [Italics mine]

And:

Our finding that participants without phrase speech as well as participants with phrase speech showed the signature pattern of faster responses in the Sentences condition compared to the Matched Symbol Sequences condition… demonstrates that it is possible for nonspeaking autistic people to acquire aspects of literacy regardless of their speech proficiency. Second and relatedly, it is frequently suggested that more positive outcomes are associated with autistic children who achieve functional speech (i.e. phrase speech) by 5 years of age... At least as far as learning foundational literacy skills, there was no difference in our sample of nonspeaking autistic adolescents and adults between those who had some phrase speech and those who did not.

Turning to the question of how these minimally-speaking and non-speaking individuals might have acquired these literacy skills, Jaswal et al. end up, in an odd reversal, admitting that “statistical regularities clearly played a role” and that

the year or more of practice participants had communicating on a letterboard held by a trained assistant may have highlighted orthographic regularities and sound–letter correspondences, though we note that the training our participants had received on the letterboard does not involve explicit instruction on these correspondences.

Indeed.

But the authors appear oblivious to the implications. Learning “orthographic regularities and sound–letter correspondences” isn’t the same as being literate. Consider the stereotypical American Bar/Bat Mitzvah in which a teenager recites passages written in Hebrew without understanding most of the words he/she is pronouncing. Few people would say that that individual is literate in Hebrew. To be literate, sounding out and spelling out letter patterns aren’t enough: you must also know the meanings of whatever it is you’re pronouncing or spelling. Yes, orthographic regularities and letter-sound correspondences are included in foundational literacy skills. But if that’s all you have, you aren’t literate and, unless circumstances change dramatically, you never will be. This is especially the case if most of your “communications” involve S2C, which, with its exclusive focus on letter positions on the S2C board and on prompting kids to point to them (“right next door,” “keep going, keep going,” “you’re almost there”), completely omits meaning.

But Jaswal is no literacy expert. As a result, he has no problem closing the article with what reads like a subtle infomercial for S2C, complete with citations from pro-FC researchers:

An important question for future work will be investigating why, given this underlying orthographic competence, most nonspeaking autistic people do not learn to express themselves in writing. As suggested earlier, part of the challenge is lack of opportunity because of underestimation of nonspeaking autistic people’s capacity to acquire literacy…

[Note the omission here of the various ways, mentioned in the opening paragraph of this blog post and seen accompanying image, in which the evidence-based AAC devices routinely used with nonspeaking autistic people are in fact designed to promote literacy.]

The significant proprioceptive and motor challenges that many nonspeaking autistic people face can also interfere with learning to write by hand or type using conventional interfaces (e.g. Gernsbacher, 2004; Leary & Donnellan, 1995; Torres et al., 2013).

[Note the FC-friendly take on autism as a motor disorder that disrupts “conventional”—i.e., independent—typing, asserted in the pro-FC literature but never actually demonstrated.]

Thus, another important area for future work will be leveraging advances in technology to create accessible and customizable communication interfaces as well as opportunities to practice the skills required to use them.

Stay tuned for future articles by Jaswal et al. on how “advances in technology” can promote sophisticated literacy in minimally-speaking individuals, with the usual conflation of evidence-based AAC technologies with communication tools that, however high-tech they may be, are ultimately facilitator-directed and facilitator-controlled.

Meanwhile, a segment within Jaswal et al.’s final paragraph reminds us of the giant elephant that has been lurking in the room the entire time:

According to the nonspeaking autistic participants in this study and their families, the most effective means of communication available to them currently involves spelling words and sentences on a letterboard held vertically by an assistant. (All the study participants are working on the skills to be able to type without assistance.) Were it not for concerns about the role of the assistant…this would serve as prima facie evidence that they are literate. We used an experimental task that did not involve an assistant (i.e. no one held the iPad or touched participants) to investigate if these participants possess foundational literacy skills. [Italics mine.]

If the participants in the study were able to type out sentences without an assistant on stationary iPads with flashing letters, then why, when typing sentences that aren’t guided by flashing letters, do they need the letterboard to be held up by an assistant?

Such an assistant, as all the available evidence suggests, is the one most likely to be controlling the messages, including the message that this is “the most effective means of communication available to me.” And such an assistant, as all the available evidence suggests, may well be the only truly literate person involved in producing such messages.


REFERENCES

Beals, K. (2021) A recent eye-tracking study fails to reveal agency in assisted autistic communication. Evidence-Based Communication Assessment and Intervention, 15:1, 46-51, https://doi.org/10.1080/17489539.2021.1918890

Beals, K. (2024) Can message-passing anecdotes tell us anything about the validity of RPM and S2C? Evidence-Based Communication Assessment and Intervention, https://doi.org/10.1080/17489539.2023.2290298

Gernsbacher M. A. (2004). Language is more than speech: A case study. Journal of Developmental and Learning Disorders, 8, 79–96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266410/

Jaswal, V. K., Lampi, A. J., & Stockwell, K. M. (2024). Literacy in nonspeaking autistic people. Autism, 0(0). https://doi.org/10.1177/13623613241230709

Jaswal, V. K., Wayne, A., & Golino, H. (2020). Eye-tracking reveals agency in assisted autistic communication. Scientific reports10(1), 7882. https://doi.org/10.1038/s41598-020-64553-9

Leary M. R., Donnellan A. M. (1995). Autism: Sensory-movement differences and diversity. Cambridge Book Review Press.

Torres E. B., Brincker M., Isenhower R. W., Yanovich P., Stigler K. A., Nurnberger J. I., Mextasas D. N., Jose J. V. (2013). Autism: The micromovement perspective. Frontiers in Integrative Neuroscience, 7, Article 32. https://doi.org/10.3389/fnint.2013.00032

Vyse, S. (2020). Of Eye Movements and Autism: The Latest Chapter in a Continuing Controversy. Skeptical Inquirer.

Wednesday, February 28, 2024

From proto-syntax to actual syntax

Many minimally verbal, severe-to-moderately autistic individuals are able to pick up, with little to no instruction, what we might call “proto-syntax”: namely, how to put nouns, verbs, and adjectives together in an order that reflects the word order rule of their native languages—whether through speech, written words, or pictures.  For English, this means putting the subject noun before the verb and the object noun after the verb:

  • I want cookie.
  • Daddy push truck.

At the two-word level, proto-syntax includes the “telegraphic speech” evinced not just by language-delayed autistic individuals, but by typically developing two year olds:

  • Truck red.
  • Mommy come.

Some people equate this sort of basic content-word ordering with actual syntax: after all, it implicitly encodes which noun is the subject and which noun is the object. But actual syntax involves so much more than how to order subject and object nouns into simple sentences.

Actual syntax involves not just content words (nouns, verbs, adjectives, adverbs, prepositions) but also verb tense endings, auxiliary verbs, and function words like articles (“a” and “the”) or, in certain contexts, words like “by” or “that.”

Actual syntax involves noun phrases, not just bare nouns: phrases that include not just the noun, but, at the very least (where English is concerned), an accompanying article. It’s what allows you to refer to “the truck” (a specific truck that’s familiar to both speaker and listener) vs. “a truck” (a novel or unspecified truck).

And actual syntax allows for sentence transformations, for example passive voice, in which the subject and object nouns are switched and a specific auxiliary verb and a specific function word are inserted into specific slots in the sentence. For example, in the sentence below, “truck” now comes first, but it is still the object, not the subject, of the verb “push.”

  • The truck was pushed by Daddy. [Here I’ve highlighted, in order: an article, an auxiliary verb, a tense ending, and a function word.]

Actual syntax also involves not just linear sequences, but structure, or groupings of words. Syntactic structure is what differentiates the two meanings of

  • He talked about sex with Dick Cavett.

Syntactic structure what tells you that “who” is the subject of “vanish” but the object of “banish” in this pair:

  • Who do you want to vanish?
  • Who do you want to banish?

And syntactic structure is what tells you that “he” can refer to “John” in the first and second sentences, but not in the third:

  • John keeps saying that he is smart.
  • It's that he's smart that John keeps saying.
  • He keeps saying that John is smart.

Besides syntactic structure, there are syntactic rules. These tell you, for example, how to map basic statements into questions:

  • She is sleeping to Is she sleeping?
  • She slept to Did she sleep? (NOT Slept she? or Did she slept?)
  • She sleeps to Does she sleep? (NOT Sleeps she? Or Does she sleeps?)

Actual syntax, in fact, has so much going on that it takes at least two semesters of advanced linguistics courses focused specifically on syntax to really appreciate what all is involved.

That said, actual syntax is not just an arcane subject for linguists, nor a sort of icing on the linguistic cake for those who are able to sequence bare nouns and verbs into basic subject-verb-object sentences. Actual syntax is the structural backbone of language and the semantic backbone of meaningful communication. It’s what allows people to express statements that go beyond the immediate here and now to the past, future, hypothetical, and counterfactual. It’s what allows reminiscences, future planning, problem solving, and precautions (“if you run into the street without looking, you might get hit by a car”). It’s what allows you to not just answer other people’s questions (which is how so many autistic individuals spend so much of their instructional hours), but to ask questions of your own.

Indeed, so important is the ability to ask questions that two prominent autism researchers, Lynn Koegel and Robert Koegel, have specifically targeted this skill as a pivotal skill that, when explicitly instructed, helps individuals with autism improve upon their conversational initiation skills—an area of significant and widespread difficulty in autism.

For me in particular, with my linguistic connections to syntax and, more importantly, my personal and professional connections to autism, syntax is so important that I’ve devoted over a decade of my professional life to developing the only software tool that teaches the full gamut of expressive syntax skills to individuals with autism.

It’s easy to underestimate what goes into such a tool—especially given the number of apps that teach one or another tiny subset of the skills involved in forming the most basic of sentences. A software tool that teaches all of the syntactic phenomena of English, with enough exercises for instruction, practice, and generalization, requires hundreds of pages of complex linguistic processing code, and thousands of pages of lesson code, developed over years of beta-testing with individuals at multiple levels of syntactic development.

Here’s just a tiny a sample of what that translates into in practice:

https://autism-language-therapies.com/HTML5/Demo1.html

Thursday, February 22, 2024

Myths about myths, validity, and natural message-passing tests, Part II

(Cross-posted at FacilitatedCommunication.org).

This post continues my critique of Jennifer  Binder Le-Pape’s recent blog post on the official Spelling to Communicate (S2C) website. This piece, as I noted earlier, professes to give readers valid, evidence-based arguments against what she calls the “top 10 myths” perpetrated by critics of Spelling to Communicate and other variants of facilitated communication (FC).

What Binder-Le Pape actually puts forth, however, are a combination of argument from authority, straw man arguments, circular reasoning, and unsupported and misleading statements. Last time I showed how this plays out in her first 5 purported myths; I pick up here at Myth 6.

Myth 6, per Binder-Le Pape, is that “It is dangerous to presume competence; an individual should prove that they are authentically communicating before participating in a public forum.” Here, Binder-Le Pape cites the legal system, which, she says, “presumes adults to be competent unless proven otherwise.” This would make it legally impermissible to assess people for competence. After all, if we’re required to presume competence, then presumably we shouldn’t be assessing it. But most of us recognize that evaluations of competence are sometimes necessary.

Standard evaluations of competence are psychological evaluations, which are supposed to be conducted without facilitators facilitating. Binder-Le Pape claims that “many individuals have undergone rigorous evaluations, only to be repeatedly questioned by detractors who demand a repeat performance or an additional one based on their preferred method.” She does not tell us what these rigorous evaluations entailed.

Myth 7, per Binder-Le Pape, is “Using prompts in the early stages of learning to use S2C renders it invalid.”  This one is a straw man. Many people recognize that prompts are needed in the early stages of learning.  The key question is whether those prompts are faded. Binder-Le Pape cites applied behavioral analysis (ABA), but here’s what ABA guidelines have to say about prompting.

Once the child has learned to touch one of two items held in front of him, training should be given on learning to touch one of two items placed on a table. The procedure is similar, but this type of trial is often a little more difficult for a child because it eliminates most inadvertent prompts (e.g., slight position, movement, or eye prompts).

(From Sundberg and Partington’s ABA-based Teaching Language to Children with Autism and Other Developmental Disabilities, italics mine).

Unlike S2C, which has no such guidelines, ABA makes a distinction between teaching prompts and inadvertent prompts, has protocols for fading inadvertent prompts as soon as possible, and recognizes the potential of slight movements, including eye gaze, to direct a client’s responses.

Myth 8: “Using S2C or related methods to take standardized tests automatically invalidates their results.” Here what constitutes debunking, for Binder-Le Pape, is simply to list the testing organizations that allow “communication and regulations partners” and “hand-held S2C laminated letterboards.” According to Binder-Le Pape, these include New York’s TASC (its GED or high school equivalency test), Philadelphia’s Keystone, and the ACT. (When I search “laminated letterboard” plus “Keystone”/”TASC”/”ACT”, nothing comes up). She also suggests that the guidelines for two IQ tests—those of the WAIS-IV, which make reference to “preferred mode of accommodation”, and those of the WISC-V, which allude to “clinical judgment” about “modification”—permit this type of “accommodation”.

Myth 9: “Some individuals have made false or unproven accusations using methods similar to S2C, and therefore, no one using these methods should be believed.”  This one is another straw man. The false abuse accusations are one of many problems with FC, but that does not, in and of itself, mean that people using these methods should not be believed. When someone makes a false accusation via FC, the first step should be a rigorous authorship test. Interestingly, these days when judges order such tests, the response has generally been to drop charges—which is quite suggestive of what the people facilitating those charges know, deep down inside, about what rigorous authorship testing would reveal.

Myth 10 is a rhetorical question “Is S2C valid, or is S2C a ‘discredited method’ that has been debunked?” Defining valid as “logically or factually sound”, Binder-Le Pape claims that her above arguments have that characteristic, and refers readers who think those arguments fall short to an earlier blog post of hers which I addressed here.

She then adds as another metric of validity “having legal force or being legally acceptable,” and goes on to cite the ADA on giving “primary consideration to the requests of individuals with disabilities” and on requiring equal educational opportunity. As all the available evidence suggests, however, S2C and its variants interfere with the ability of individuals with disabilities to make requests and diminish their educational opportunities.

Binder-Le Pape also cites the guidelines of the American Speech-Language-Hearing Association (ASHA) on evidence-based practices, noting that they include “clinical expertise/expert opinion,” “evidence”, and “client/parent/caregiver perspectives.” Re the last two, she alludes to her earlier arguments, “valid” as they are in her view. Re clinical expertise/expert opinion, she cites the many speech-language pathologists, occupational therapists, and people with special ed degrees who have come to believe in S2C. She leaves out ASHA’s position statements against S2C and its variants.

Binder-Le Pape concludes by reminding us of the “many, many universities, colleges, government committees, nonprofits, researchers, professors, teachers, doctors, psychologists, occupational therapists, lawyers, and journalists" who support S2C.

The constant appeals to authority throughout this post are a huge red flag. If the strongest case you can make for a particular practice is that most authorities accept that practice, you are on thin ice—particularly if you bear in mind the long history of bigotry in the past century and earlier, including bigotry against people with disabilities, by large numbers of authorities in politics, academia, and journalism.

But Binder-Le Pape is confident that this time the authorities—at least the ones she cites—are on the right side, in contrast to the “small group of detractors” she returns to in her closing remarks.

FC proponents never seem to ask themselves what motivation this “small group” could possibly have for undermining the authentic communications of society’s most vulnerable members.  In fact, we do the opposite. Not only do we advocate against the communication-suppressing practices of S2C and other variants of facilitated communication; many of us have devoted long hours to inventing innovative assistive devices or language teaching tools designed to enhance the independent, authentic communication of minimally speaking individuals.

Naturally, some of our detractors have asserted, without evidence, that we make large amounts of money off of these endeavors: that that’s why we oppose S2C, and that we’re the ones cynically exploiting desperate parents and their vulnerable children.  My guess is that the peddlers of S2C et al, with those “thousands of hours of practice” leading to apparently miraculous language and literacy skills, and the hours of ongoing communication and regulations partnering that many parents outsource to clinics and clinicians, make far more money off of desperate parents than any of us do with our decidedly non-miraculous, low-labor-intensive, assistive and teaching technologies.

These days especially, “skeptic” has a bad ring—and not just when used as a pejorative suffix to words like “climate” and “vaccine.” But the true skeptics I’ve met, including members of this “small group,” are some of the kindest, humblest, most self-effacing people I know. When we critique the opposition, we critique their claims and lack of evidence; we don’t make personal attacks or say nasty things about them behind their backs. Perhaps that’s no accident: when one puts evidence first and insists on being guided by that evidence, that tends to minimize one’s cognitive dissonance—along with the nastiness that cognitive dissonance often gives rise to—and to deliver regular doses of humility.

REFERENCES

Beals, K.P. (2024) Can message-passing anecdotes tell us anything about the validity of RPM and S2C?, Evidence-Based Communication Assessment and Intervention, DOI: 10.1080/17489539.2023.2290298

Sundberg, M. L., & Partington, J. W. (2013). Teaching language to children with autism and other developmental disabilities. Behavior Analysts.

Thursday, February 15, 2024

Several reasons to doubt that rates of autism are going up

Do increases in diagnosed autism reflect significant increases in actual rates of autism, which here in the U.S. now stands at 1 out of 36?

Source: Wikipedia

There are several reasons to think that the answer is probably "no."

First, even the most recent peer-reviewed journal articles propose that expansions of the diagnostic criteria and of reporting practices are primarily responsible for apparent increases in autism rates.

A 2021 British study, for example, concludes:

Increases could be due to growth in prevalence or, more likely, increased reporting and application of diagnosis. Rising diagnosis among adults, females and higher functioning individuals suggest augmented recognition underpins these changes.

And a 2020 U.S. study of autism in the public schools reports:

Although the impact of environmental or genetic influences cannot be entirely ruled out, we identified significant shifts in eligibility trends that substantially contribute to the remarkable increase in autism prevalence.

And then there's this data from 2000-2010, which suggests that increasing numbers of cases once classified as intellectual disability are now classified as either autism or as autism plus intellectual disability:


Reclassification of those with intellectually disabilities, and greater identification of autism in higher functioning individuals, predicts increases in rates of severe autism and mild autism, but not increases in rates of moderate autism. 

That's because in moderate autism is hard to confuse with intellectual disability, and even harder to confuse with neurotypicality. In moderate autism there's often no intellectual disability as measured by non-verbal IQ tests, and even where there is a measured intellectual disability, it's overshadowed by the autism symptoms. Moderate autism, moreover, by definition involves more profound social and restrictive/repetitive behaviors than mild autism, and so is far less likely than mild autism to be completely overlooked.

So if those who are convinced that autism is becoming more prevalent want to convince the rest of us, they might start by demonstrating that rates of mid-spectrum autism--which is arguably the most prototypical subset of the spectrum--are rising in tandem with the rates of autism at the severe and mild tail ends of the spectrum.

Wednesday, February 7, 2024

Myths about myths, validity, and natural message-passing tests, Part I

 (Cross-posted at FacilitatedCommunication.org).

Curiously, moments after my latest piece in Evidence-Based Communication Assessment and Intervention came out (more on that later), a January blog post on the official Spelling to Communicate (S2C) website crossed my radar. This piece, by S2C promoter and parent Jennifer Binder-Le Pape, professes to give readers valid, evidence-based arguments against what she calls the “top 10 myths” perpetrated by critics of Spelling to Communicate and other variants of facilitated communication (FC).

What Binder-Le Pape actually puts forth, however, are a combination of argument from authority, straw man arguments, circular reasoning, and unsupported and misleading statements.

Among the authorities she cites is herself. In her professional capacity as a strategy consultant, she says, is it her job “to dive into facts and data when confronted with conflicting opinions.” So that’s what she did, she says, with S2C. And in “examining the evidence,” she has learned that “unfavorable views” of S2C are due to “outdated assumptions about autistic individuals.” She does not cite any facts that support this claim.

She also tells us that her son has “shown” numerous professionals that S2C is effective. She does not describe the nature of this demonstration. Instead, she cites the “increasing number of conferences, nonprofits, universities, and media outlets” that now embrace S2C.

She contrasts these authorities with a “small but vocal group of people who seem determined to shut down these efforts at inclusion by insisting that these forms of communication are somehow illegitimate.” This group, she says, holds “opinions” that they present as “the scientific consensus”—which she claims is “incorrect at best and arguably intellectually dishonest.”

The most relevant scientists among whom to solicit a consensus, of course, are those who study language and communication skills in autism, and those who study assisted communication and the potential for cuing and message control by facilitators. Is there a lack of consensus among the scientists who specialize in these areas, and who know about S2C, about the validity of S2C? I wouldn’t be so sure. Many of them keep quiet—perhaps because they know what happens if they speak up.

Critics of S2C and other variants of FC are routinely accused by proponents of FC of espousing hate and causing harm to individuals with disabilities.  Binder-Le Pape is no exception. She cites claims by S2C users that members of the “small but vocal” group of critics have mocked them and hurt their feelings. These claims, of course, are generated by S2C and therefore are only valid if S2C is valid.

But Binder-Le Pape doesn’t go there; instead, she offers consolation to those who have purportedly been harmed by citing the words of civil rights activist James Baldwin. She also cites the Americans with Disabilities Act.

And then she turns to the ten purported myths.

The first is that no research supports S2C. Binder-Le Pape counters this “myth” by claiming the existence of a “growing body” of S2C-supporting research. The only examples she cites—all of them familiar to us at FacilitatedCommunication.org—date back to 2020 and earlier.

First, she cites Elizabeth Torres, an outspoken believer in all forms of facilitated communication who believes that her research supports a reanalysis of autism as a “micro-movement disorder.” Instead of citing Torres’ research directly, however, Binder-Le Pape cites a 2019 interview with the pro-FC organization “Thinking Person’s Guide to Autism.” Torres’ most recent empirical article about micro-movements in autism, however, dates back to 2013, and we critiqued it here two weeks ago. As I discussed, nothing in that article explains the need for the held-up letterboards and hovering prompters that characterize S2C; in fact, in several ways, Torres’ article undermines the case for S2C.

Next, Binder-Le Pape cites Alexis Woolgar’s work on “hidden ability in autism”, which she describes as “us[ing] portable EEGs to measure specific types of brain activity to establish nonspeaking individuals’ complete comprehension of spoken language.” If you follow the link she provides, you discover that this is not a study at all, but rather a research goal:

We would like to learn more about how their brains process spoken words, using brain imaging technologies that are gentle and fast to set up. The aim of our research is to provide a chance for autistic people to demonstrate how well they understand word meanings.

Binder-Le Pape also cites Phase 1 of an actual study by Woolgar’s lab, but, as you can quickly tell from the abstract, the participants were 20 neurotypical children; no study participants were autistic. None of Woolgar’s actual research, in other words, amounts to any evidence of “complete comprehension of spoken language” by nonspeaking individuals, let alone evidence for the validity of S2C.

The one study cited by Binder-Le Pape that actually does purport to find evidence for S2C is Vikram Jaswal’s infamous eye-tracking study. But this article has been critiqued multiple times for flawed assumptions and flawed methodology, for example here and here. To date, no S2C proponent has publicly critiqued these critiques; at least in public, proponents behave as if these critiques don’t exist.

Finally, Binder-Le Pape refers readers to the articles listed on the pro-FC United for Communication Choice (UCC) website. Many of these are not relevant to FC; most are only indirectly relevant. All of the latter have been critiqued on this website, mostly on this page.  It’s notable that the most recent study in the UCC database dates to 2022.

So much for the evidence that supports S2C. Nor do Binder-Le Pape’s citations show that long-standing assumptions regarding autism are “outdated.” Some dozen decades after Leo Kanner coined the term, autism is still clinically defined as involving low levels of social engagement and high levels of restrictive/repetitive behaviors. And a growing body of clinical data, including a very recent eye-tracking study, shows that the low levels of social engagement begin in early infancy. This diminished social engagement tracks with autism severity and derails the acquisition of language, such that the sophisticated vocabulary and sentence structures of messages generated through FC are extremely unlikely to have been generated by those who are most commonly subjected to FC.

Binder-Le Pape concludes her discussion of the first “myth,” the purported myth that no research supports S2C, by citing the words of S2C families and S2C users, thus returning to the circular arguments with which she opened her blog post. We know their communications are authentic because they say they are; we know that S2C works because they say it works.

Michel Bakni, Wikimedia Commons

Binder-Le Pape’s second myth is that “individuals who spell and type to communicate have nothing original to say, and they parrot the beliefs of their communication partners.” This misstates what critics have actually said, which is that all the available evidence suggests that the communication partners are controlling the messages. This likely message control, in turn, makes it impossible to know what the individuals subjected to S2C have to say, as their words are likely being hijacked by others.

Binder-Le Pape doesn’t seem to realize that there’s a distinction between an FCed person parroting a facilitator’s beliefs and a facilitator controlling the facilitated messages. In the case of parroting, the output reflects the facilitator’s beliefs; in the case of control, the output reflects what the facilitator ascribes (however subconsciously) to the facilitated person. Binder-Le Pape brings up cases of FC-generated opinions that differ from the opinions of facilitators, and FC-generated reports of synesthesia that facilitators themselves don’t experience, and assumes that these differences are evidence that the FC-generated messages can’t be authored by the facilitators. It doesn’t seem to occur to her that one can author a message that reflects beliefs that one ascribes to someone else—which is what all the available evidence suggests is precisely what facilitators are (however subconsciously) doing.

Instead, what we get is more circular reasoning: FC-generated messages are evidence that these FCed individuals have something original to say and that they have difficulty controlling their bodies—and that, therefore, FC is valid. FC is valid because FC is valid.

Myth 3, per Binder-Le Pape, is that “S2C hasn’t proved useful in academic settings.” Her evidence for this is more circular reasoning: through S2C-generated output, S2C-ed individuals are completing high school, attending college, graduating college, and putting “the skills they honed in college to good work.” But S2C has allowed them to do this only if the S2C-generated output is theirs, and not that of their facilitators. Again, S2C is valid because S2C is valid.

Besides the circular reasoning, there’s the argument from authority. Binder-Le Pape cites Harvard, Berkeley, UCLA, Tulane, Oberlin, and Rollins as institutions that have enrolled and graduated individuals she characterizes as “non-speaking autistics who type and spell to communicate”. She also cites Time, Newsweek, Fortune, and Psychology Today as having published the typed output of one of these individuals. S2C is valid, in other words, because all these prestigious institutions behave as if it’s valid.

Myth 4: per Binder-Le Pape, is that “using a CRP [‘communication and regulations partner,’ or facilitator] prevents individuals from developing independent typing skills.” She concedes, without explaining why, that “achieving independence requires thousands of hours of practice.” Nor does she supply any evidence that any S2C-ed individual ever attains independence. True communicative independence, as we have repeatedly explained, includes the ability to type spontaneous messages that match earlier, FCed levels of sophistication without any of one’s facilitators/CRPs within auditory or visual cueing range.  

Instead, Binder-Le Pape proceeds to cite the S2C-generated words of those subjected to S2C, some of whom “say they prefer communicating on a laminated board, as it is faster and more comfortable for them.”  The circularity continues: once again, S2C-generated messages are cited as evidence that S2C-generated messages are valid.

Myth 5 is that “a message-passing test under controlled conditions is the only way to establish an individual’s independent communication.” No, she insists, a message-passing test is only one way; “direct observation” and eye-tracking are alternatives. We’ve already noted problems with Jaswal’s eye-tracking study and seen how other eye-tracking data (the data about diminished attention to social stimuli) has been unfavorable to FC. As for direct observation, it is susceptible to a well-known psychological fallacy known as naïve realism. As anyone who has attended magic shows knows, at least in the context of magic shows, you can’t always believe what you see.

Finally, Binder-Le Pape discusses natural message-passing tests—and this takes me back, as promised, to my just-published article, entitled Can message-passing anecdotes tell us anything about the validity of RPM and S2C? Here I show why naturalistic message-passing tests, including those cited by Binder-Le Pape and others, cannot be used as evidence in support of FC.

We’re half-way through the myths, and this post has gone on long enough, so we’ll pick up next time at Myth 6.

REFERENCES

Beals, K. (2021). A recent eye-tracking study fails to reveal agency in assisted autistic communication. Evidence-Based Communication Assessment and Intervention, 15(1), 46–51. https://doi.org/10.1080/ 17489539.2021.1918890

Beals, K.P. (2024) Can message-passing anecdotes tell us anything about the validity of RPM and S2C?, Evidence-Based Communication Assessment and Intervention, DOI: 10.1080/17489539.2023.2290298

Jaswal, V. K., Wayne, A., & Golino, H. (2020). Eyetracking reveals agency in assisted autistic communication. Scientific Reports, 10(1), 7882. https://doi.org/10.1038/s41598-020-64553-9

Petit, S., Badcock, N. A., Grootswagers, T., & Woolgar, A. (2020). Unconstrained multivariate EEG decoding can help detect lexical-semantic processing in individual children. Scientific reports10(1), 10849. https://doi.org/10.1038/s41598-020-67407-6