Autistic readers and pre-modern literature: do they really "want abilities"?

In my various autism classes, I routinely discussed the challenges that autistic readers have with non-literal language. 

These challenges are familiar to many who've spent time talking to autistic individuals. People routinely cite examples like “raining cats and dogs,” “Can you pass the salt?” and “I’m stuck”. But these actually aren't the best examples of the problem.

That's because these phrases are so commonly used non-literally, and so rarely used literally, that one can simply acquire and memorize their non-literal meanings in the same way one does with words that have more than one meaning.

Rather, what’s problematic for autistic readers and listeners are expressions whose intended meanings aren’t currently conventional: for example, less common, hackneyed ones like “your essay needs some signposts” or “the cadenza was mischievous.” In the absence of common, conventional, non-literal meanings, the literal meanings of these expressions are the most salient. To override them as unlikely in context, the listener/reader must consider that context in full: the big picture; the larger discourse/text; what the speaker/writer is or isn’t plausibly trying to communicate. Does your English teacher really want you to attach actual signposts to your essay? How likely is a cadenza to be literally mischievous, or for the music reviewer to think it is? What is the most likely alternative meaning? Perhaps some metaphorical extension of the literal one?

More recently, as I immerse myself for homeschooling purposes in the prose of Austen, Bronte, Hawthorne, and Bulfinch, I’m noticing another way in which the literal-minded autistic reader could be led astray. Hundred-plus-year-old texts house scores of obsolete idiomatic expressions and words whose meanings have drifted significantly since they were originally put to paper.  Consider "intercourse" for social interaction; "check" for limit; "suffer" for allow; "late" for recent; "discover" for reveal; “host” for army; “closet” for private room; "in a body" for as a group; "gay" for happy; “fix” for sabotage and “want” for need or lack. Consider how someone who can’t get beyond what today’s literal meaning of “fix” and “want” will misinterpret “Pelops bribed the charioteer to fix the chariot” or "Mr. Darcy can please as he chooses. He does not want abilities".

Of course, neurotypical readers, particularly those who don’t have much experience with older texts and semantic drift, may also struggle with these shifted meanings. Only the most discerning and semantically flexible young readers, I’m guessing, will deduce from context alone what it means for the bribed charioteer to “fix a chariot” or for Mr. Darcy to “not want abilities.” But, to the extent that neurotypical students are more sensitive to what’s plausible given the bigger picture, they are at least more likely than their autistic counterparts to dismiss the literal meaning, and thus--even if they don't come up with a meaningful alternative—not be led totally astray.

The best teachers, of course, will go over the obsolete and archaic meanings, sharpening everyone’s appreciation for older literature and, in the process--to use a still quite commonplace and conventionalized, even hackneyed metaphor--leveling the playing field for everyone.

Do facilitated individuals have apraxia issues that explain away the concerns about FC?

 (Cross-posted at FacilitatedCommunication.org).

In my last post I wrote about motor difficulties in autism and argued that these challenges, however widespread they may be, do not explain away the myriad empirical problems with facilitated communication. In this follow-up post I’d like to zero in on one particular motor control issue: motor planning, AKA apraxia. My reasons are twofold. First, among the various actual and purported motor difficulties in autism, apraxia is the one most often cited by FC proponents.  Second, one of the most common critiques levied by FC proponents against FC critics is that we don’t understand apraxia and how it validates FC.

For FC proponents, the story goes as follows. Apraxia, specifically apraxia of speech, is the reason for both the deficits in, and the purported unreliability of, speech in severe autism. Meanwhile, a more general apraxia is the purported reason for index-finger typing that is facilitated (whether through touch, verbal prompts, and/or held-up letterboards) by a designated communication partner who is always within tactile, auditory, and/or visual cueing range. This more general apraxia is also the purported reason for discrepancies between the FCed messages and ways in which the facilitated person actually behaves—whether before, after, or during facilitation.

Let’s start with what FC proponents say about apraxia of speech.  Many proponents, from Douglas Biklen (Biklen et al., 1992), who introduced FC to the U.S., to Elizabeth Vosseller, who is credited with inventing one of the most recent variants of FC (Spelling to Communicate or S2C), argue that apraxia of speech is part of a more general language apraxia that also includes ten-finger typing. This apraxia, they say, amounts to a disconnect between the motor and language systems of the brain. According to one of the FC proponents mentioned in my last post, “They say things that they didn’t intend to say”.

But that’s not quite what the professionals say about apraxia of speech (commonly abbreviated as AOS), AKA childhood apraxia of speech (commonly abbreviated as CAS). For those who actually specialize in speech-language disorders, AOS/CAS (1) does not include ten-finger typing, and (2) involves something much more specific than a general disconnect between motor and language systems or saying things you didn’t intend to say. Core to AOS/CAS, rather, is difficulty planning and coordinating your speech movements. This might, for example, involve saying “totapo” or “topato” instead of “potato.”

As defined by the American Speech Language Hearing Association (ASHA), AOS/CAS involves:

• A limited consonant and vowel repertoire.
• Minimal variation between different vowel sounds.
• Vowel errors and distortions.
• Inconsistent errors and idiosyncratic error patterns.
• Reduced rate or accuracy with diadochokinetic tasks [how quickly you can accurately repeat a series of rapid, alternating sounds like “puh-tuh” and “puh-tuh-kuh”]
• Oral groping behaviors [resorting to trial and error tactics for making speech sounds]
• Prosodic differences (reduced rate, excess or equal stress, “choppy” words and syllables, monotone speech).
• Increased errors with increased length or complexity of utterances.
• More difficulty with volitional utterances compared to modeled or automatic utterance.

And according to ASHA’s Technical Report, AOS/CAS involves:

1. inconsistent errors on consonants and vowels in repeated productions of syllables or words;
2. lengthened and disrupted coarticulatory transitions between sounds and syllables; and
3. inappropriate prosody, especially in the realization of lexical or phrasal stress.

As Terband et al. note, ASHA’s definition of AOS:

has been adopted widely in the CAS [Childhood Apraxia of Speech] research literature (e.g., Grigos & Kolenda, 2010; Iuzzini-Seigel, Hogan, Guarino, & Green, 2015; Maas & Farinella, 2012; Murray, McCabe, Heard, & Ballard, 2015; Namasivayam et al., 2015; Preston et al., 2014; Terband, Maassen, Guenther, & Brumberg, 2009, 2014).

As Cassidy (2016) sums up AOS:

Patients with apraxia of speech have very slow, deliberate, effortful speech. They may make errors in the shape, ordering and timing of the production of individual syllables and may display ‘articulatory groping’, repeatedly correcting themselves while trying to find the right word or sound. They also have greatly impaired prosody of speech, such that it loses its natural rhythm, intonation and overall melody. .. they then often struggle significantly when asked to string a number of syllables together (eg, ‘pa-ta-ka, pa-ta-ka, …’).

One way to get real a handle on what AOS is and what AOS isn’t is to look at how it’s evaluated. According to the Mayo Clinic, in an AOS evaluation:

Your child’s ability to make sounds, words and sentences will be observed during play or other activities.

Your child may be asked to name pictures to see if he or she has difficulty making specific sounds or speaking certain words or syllables.

Your child’s speech-language pathologist may evaluate your child’s coordination and smoothness of movement in speech during speech tasks. To evaluate your child’s coordination of movement in speech, your child may be asked to repeat syllables such as “pa-ta-ka” or say words such as “buttercup.”

If your child can produce sentences, your child’s speech-language pathologist will observe your child’s melody and rhythm of speech, such as how he or she stresses syllables and words.

Your child’s speech-language pathologist may help your child be more accurate by providing cues, such as saying the word or sound more slowly or providing touch cues to his or her face.

Gubiani et al. (2015) describes several specific tests: the Verbal Motor Production Assessment for Children (VMPAC), the Dynamic Evaluation of Motor Speech Skill (DEBMP), the Kaufman Speech Praxis Test for Children (KSPT), and the Madison Speech Assessment Protocol (MSAP).  Across these tests, the majority of items involve imitating increasingly complex vowel and consonant combinations. The KSPT, for example, has the child imitate isolated vowels, vowel combinations (diphthongs) like “ai” and “ou”, consonants, different types of syllables and repeated syllables, and, finally, spontaneous speech.  And the DEBMP has the child imitate consonant-vowel (e.g., “me” and “hi”), vowel-consonant (e.g., “up” and “eat”), duplicate syllables (e.g., “mama” and “ booboo”), consonant-vowel-consonant (e.g., “mom” and “bed”), two syllable words (e.g., “baby” and “ happy”), multisyllabic (e.g., “banana” and “kangaroo”), and increasingly long phrases (e.g., “dad,” “hi dad,” “hi daddy”).

Terbald et al. (2019) also discuss specific tasks for diagnosing AOS/CAS that appear across a wide range of AOS studies. These include multi-syllabic words like “elephant” and “spaghetti”; phrases involving consonant repetitions (“Buy Bobby a puppy” and “Well we’ll will them”) or a variety of consonants (“Tony knew you were lying in bed”); nonsense word repetitions (e.g., “pib”, and “pub”); repetitions of contrasting minimal pairs (e.g., “pil–bil”, “tennis–dennis”); one-, two-, and three-syllable words (“pop,” “puppet,” and “puppypop”) repeated multiple times in random order; repetitions of a variety of different consonant-vowel combinations; and pronunciation of multisyllabic words with a variety of stress (accent) patterns. In discussing error types, Terbald et al discuss phonetic distortions, phonemic errors, and prosody errors.

As Gubiani et al. put it, what these AOS tests have in common is that they assess “the oral structures and/or motor function of speech”, and to some extent, the child’s speech prosody [speech rhythm and melody]. All this is consistent with how AOS is characterized both by ASHA and by the Mayo Clinic.

As far as FC is concerned, the takeaway here is that AOS is about difficulty reliably producing words, particularly complex ones like “potato”, not difficulty suppressing incorrect words. A child with apraxia who intends to say “potato” might reverse the sounds and say “topato”; what he or she won’t do is land on a phonetically unrelated word like “blanket.” That is, while AOS involves making sounds you didn’t intend to make because of difficulties with motor planning, it doesn’t involve saying completely different words from those you intended to say. And so, for example, AOS does not involve saying “No more! No more!” while you’re typing out a message about telling someone how you feel about them.

Two other things are worth noting. One is that, within the subpopulation of autistic individuals who produce little-to-no speech, AOS is impossible to diagnose. True, ASHA’s first criterion is “a limited consonant and vowel repertoire.” But this, alone, isn’t diagnostic: there are other disorders that limit consonant and vowel production. What distinguishes AOS is difficulty producing combinations of vowels and consonants, as well as inconsistent successes and failures. The smaller a child’s consonant and vowel repertoire, the harder it is to detect these difficulties and inconsistencies.

Also impossible to diagnose are those who don’t respond to prompts to imitate sounds—either because they lack the receptive language needed to understand these prompts, or because they lack the social motivation to respond. (Both of these factors, it’s worth noting, are hallmarks of severe/profound autism). Furthermore, as I discussed in an earlier post, where severe/profound autism is concerned, there are alternative explanations for non-speaking and minimally-speaking that have nothing to do with apraxia of speech.

Side note: there has been some disagreement on overall rates of AOS in autism. FC proponents have cited one study (Tierny et al., 2015) as showing that 64% of autistic children have apraxia of speech. However, this study only included children with communication delays. Other studies (Shriberg et al., 2011 and Cabral & Fernandez, 2021) find little-to-no correlation between autism and AOS.

Moving beyond AOS, what sort(s) of apraxia accounts for facilitated, index-finger typing and for discrepancies between the FCed messages and ways in which the facilitated person actually behaves?

Biklen, as we saw, included independent typing under a more general sort of language apraxia. This, purportedly, could be remediated via classic FC: by stabilizing the individual’s hand movements (see also Crossley & McDonald, 1980; Jacobson et al., 1995). As I noted in my last post, however, pointing difficulties do not come up in any of the published research or assessments of motor challenges in autism, apraxia included.

Vosseller, meanwhile, claims that index finger typing, as opposed to speech and ten-finger typing, is a gross motor activity, and so is a way to bypass the purported fine-motor apraxia that she and other S2C proponents claim characterizes autism. As I noted in my last post, however, pointing is a fine motor skill, not a gross motor skill.

So much for those arguments.

And for discrepancies between the FCed messages and ways in which the facilitated person actually behaves, we mostly have anecdotal reports: specifically, reports extracted, through FC, from facilitated individuals. Philip Reyes, for example, purportedly claims (via the Rapid Prompting Method, or RPM) that apraxia causes “my body [to do] something foolish like throwing a random object instead of obeying the order of cleaning up.” And Ben Breaux purportedly claims, also through RPM, that, due to apraxia, he is unable, when asked, to put three teaspoons of sugar in a cup until he types out what the steps are (via RPM).  

A slide from a presentation on apraxia attributed to Ben Breaux

There is a grain of truth here, inasmuch as apraxia can involve difficulties with motor sequences. But the sorts of apraxia recognized by actual experts do not include the phenomena described here by Breaux. Proposed non-speech apraxias (see Wikipedia for a review) include limb-kinetic apraxia (which mostly pertains to finger movements, e.g., tying shoes or typing); gait apraxia (difficulty walking); constructional apraxia (e.g., difficulty copying a simple diagram or drawing basic shapes); and oculomotor apraxia (difficulty moving the eyes on command). Some have argued, however that the last three aren’t true instances of apraxia, as apraxia, by definition, “involves skilled motor tasks secondary to a disturbance of higher level motor function” (See Cassidy, 2015).

Possibly more relevant to the claims attributed to Philip Reyes and Ben Breaux, at least at first glance, are two other sorts of apraxia: ideational apraxia and ideomotor apraxia.

In ideational apraxia (see Cassidy, 2015), “the concepts of movement and intent are degraded” and patients may lack “conceptual or semantic knowledge” about the appropriate use of a particular tool. As Cassidy explains:

Patients presented with a pair of scissors, for example, can name the object correctly but may be unable to describe their use. When the examiner demonstrates their use, patients may be unable to discriminate between poorly executed movements and properly executed movements. When handed the item themselves, they may struggle to use them to cut a sheet of paper.

…

The idea is that a patient with ideational apraxia may be unable to demonstrate the action because they have lost the semantic memory associated with the tool, but if they can see how it should be used then they can still access their largely intact action production system to then produce a good imitation…

Ideomotor apraxia, meanwhile, involves impairments in the action production system. It impairs, in particular, the ability to pantomime. As Cassidy explains:

Affected patients display errors in the scaling, timing and orientation of movements and may also omit or repeat individual elements of the overall action being assessed. They… often perform poorly when asked to pantomime an action. A common error is the ‘body-part-as-object error’, where the patient substitutes a body part for the tool in question when asked to pantomime a particular action…

Despite these difficulties, the goal of the action can usually be recognised, and… the patient’s performance significantly improves if they are given the object they have just been asked to pantomime…

Neither ideomotor nor ideational apraxia, on close inspection, includes difficulties in adding three teaspoons of sugar to a cup that go away when you first type out the directions, let alone throwing a random object instead of cleaning up a room.

The more I think about those discrepancies between what a person types and how they act—whether or not FC is part of the picture—the more I think of a certain old saying that often gets lost in the dust.

Actions speak louder than words.

REFERENCES/FURTHER READING

ASHA Technical Report on Childhood Apraxia of Speech https://www.asha.org/policy/tr2007-00278/

Biklen, D., Morton, M. W., Gold, D., Berrigan, C., & Swaminathan, S. (1992). Facilitated communication: Implications for individuals with autism. Topics in Language Disorders,12(4), 1-28. https://doi.org/10.1097/00011363-199208000-00003

Cassidy A. (2016). The clinical assessment of apraxia. Practical neurology, 16(4), 317–322. https://doi.org/10.1136/practneurol-2015-001354

Cabral, C., & Fernandes, F. (2021). Correlations between autism spectrum disorders and childhood apraxia of speech. European Psychiatry, 64(Suppl 1), S209. https://doi.org/10.1192/j.eurpsy.2021.557

Crossley, R. 1997. Speechless: Facilitating Communication for People Without Voices. Dutton.

Gubiani, M. B., Pagliarin, K. C., & Keske-Soares, M. (2015). Tools for the assessment of childhood apraxia of speech. CoDAS, 27(6), 610–615. https://doi.org/10.1590/2317-1782/20152014152

Shriberg, L. D., Paul, R., Black, L. M., & van Santen, J. P. (2011). The hypothesis of apraxia of speech in children with autism spectrum disorder. Journal of autism and developmental disorders, 41(4), 405–426. https://doi.org/10.1007/s10803-010-1117-5

Terband, H., Namasivayam, A., Maas, E., van Brenk, F., Mailend, M. L., Diepeveen, S., van Lieshout, P., & Maassen, B. (2019). Assessment of Childhood Apraxia of Speech: A Review/Tutorial of Objective Measurement Techniques. Journal of speech, language, and hearing research : JSLHR, 62(8S), 2999–3032. https://doi.org/10.1044/2019_JSLHR-S-CSMC7-19-0214

Tierney, C., Mayes, S., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How Valid Is the Checklist for Autism Spectrum Disorder When a Child Has Apraxia of Speech?. Journal of developmental and behavioral pediatrics : JDBP, 36(8), 569–574. https://doi.org/10.1097/DBP.0000000000000189

Confusing "relevance" with accessibility

 “Kids need assignments that they can relate to.” Within today’s Edworld, one of the most pervasive and enduring notions is that students should be reading and writing about stuff they can connect to their personal lives. As educational outsiders have pointed out, this assumes kids can’t be interested in things that are distant, whether in time and place, from the mundane and familiar. It excludes the possibility that the long ago, the far away, or the esoteric, might engage children precisely because they are long ago, far away, or esoteric. But isn’t school supposed to open doors rather than close them? Isn’t it supposed to take children out of their egocentric worlds to places they’ve never been before?

In one sense, the Edworld does have a point. While it’s not the case that kids can’t be engaged by exotic or unfamiliar material, it is true that such material can be harder to make sense of. Works set in faraway times and places—particularly if they were also written in these faraway times or places—may employ an unfamiliar vocabulary and sentence structure, or assume an unfamiliar knowledge base. If enough words, sentences structures, or presupposed facts are elusive, it’s hard to get much out of the material, let alone actually enjoy it—even if you take the trouble to look everything up.

The Edworld’s recent harping on “relatable” material, furthermore, may reflect current realities. Blame screen time: blame social media; blame long-form TV shows that scratch the itch that used to drive people to read novels: for any number of reasons, today’s kids are doing less and less independent reading. Aggravating this, K-12 classes—particularly K-8 social studies classes—are providing less and less instruction in general background knowledge—whether about civics, power structures, military concepts, or life in Regency England. The result is that much of what kids used to readily relate to, however far away in time and setting, is no longer so accessible.

I suspect this is one reason why history is less and less popular—to the point where some history teachers resist teaching straight-up history. Consider these passages from "The American Vision", a high school history text used in Philadelphia’s public high schools:

One of the most contentious developments of Jackson’s presidency was his campaign against the Second Bank of the United States. Like most Westerners and working people, President Jackson was suspicious of the Bank. He regarded it as a monopoly that benefitted the wealthy elite.
…
The bank had done a good job stabilizing the money supply and interest rates, but many western settlers, who needed easy credit to run their farms, were unhappy with the Bank’s lending policies…

What is meant by “the money supply” and “interest rates”? How would a national bank benefit the wealthy elite? What is “easy credit,” and why is it needed to run farms?

At first, excitement about the war inspired many Northern and Southern men to enlist, swamping recruitment offices and training camps. As the war dragged on and causalities rose, however, fewer young men volunteered, forcing both governments to resort to conscription.

What does “enlist” mean? What are “recruitment offices”? What is “conscription”?

To pass a new tariff, Taft needed the help of Speaker of the House Joseph G. Cannon. As Speaker, Cannon appointed all committees and decided which bills they handled. By exercising almost total control over debate, Cannon could push some bills through without discussion and see that others never came to a vote.

What does “exercising almost total control over debate” mean; why do Cannon’s powers as speaker lead to that control; and how does that control enable him to allow or prevent bills from coming to a vote?

These are all questions, I’m sure, that most of us can readily answer. But how many high school students have been provided with this vocabulary and background knowledge—which is not explained in situ in the Glencoe text? And how many of them are turned off to the material—and more generally hate history--simply because of this lack of preparation?

Moving on to Regency England, consider these passages from Pride and Prejudice:

Mr. Bennet's property consisted almost entirely in an estate of two thousand a year, which, unfortunately for his daughters, was entailed, in default of heirs-male, on a distant relation; and their mother's fortune, though ample for her situation in life, could but ill supply the deficiency of his. Her father had been an attorney in Meryton, and had left her four thousand pounds.

“Entailed on a distant relation”? “In default of heirs-male?” “The deficiency of his”?

Mrs. Bennet was prevented replying by the entrance of the footman with a note for Miss Bennet; it came from Netherfield, and the servant waited for an answer. Mrs. Bennet's eyes sparkled with pleasure, and she was eagerly calling out, while her daughter read -- 

"Well, Jane, who is it from? what is it about? what does he say? Well, Jane, make haste and tell us; make haste, my love."  

"It is from Miss Bingley," said Jane, and then read it aloud.  

"My dear Friend, -- If you are not so compassionate as to dine to-day with Louisa and me, we shall be in danger of hating each other for the rest of our lives, for a whole day's tête-à-tête between two women can never end without a quarrel. Come as soon as you can on the receipt of this. My brother and the gentlemen are to dine with the officers. -- Yours ever,
"CAROLINE BINGLEY." 

"With the officers!" cried Lydia. "I wonder my aunt did not tell us of that."  

"Dining out," said Mrs. Bennet; "that is very unlucky."  

"Can I have the carriage?" said Jane.  

"No, my dear, you had better go on horseback, because it seems likely to rain; and then you must stay all night."  

"That would be a good scheme," said Elizabeth, "if you were sure that they would not offer to send her home."  

"Oh! but the gentlemen will have Mr. Bingley's chaise to go to Meryton; and the Hursts have no horses to theirs."  

"I had much rather go in the coach."  

"But, my dear, your father cannot spare the horses, I am sure. They are wanted in the farm, Mr. Bennett, are not they?"  

"They are wanted in the farm much oftener than I can get them."  

"But if you have got them to-day," said Elizabeth, "my mother's purpose will be answered."

Even if they have figured out by now that Mrs. Bennett wants Jane to end up marrying Mr. Bingley (in part because Mr. Bennet's property being “entailed, in default of heirs-male, on a distant relation”), how many of today’s 9th graders will have the background knowledge (about horses vs. carriages and the significance of rain) required to make sense of this passage? Is the “carriage” the same as the “coach”? What is a “chaise”? Why Jane would have to “stay over” if she goes on horseback and it rains? What does Mr. Bennett mean by "They are wanted in the farm much oftener than I can get them”? What does Elizabeth mean by "But if you have got them to-day, my mother's purpose will be answered”?

Again, all of us may readily answer these questions, but how many students have absorbed enough of the relevant background knowledge by 9th grade? How many teachers are carefully going over and explaining these passages as needed?

When people today say they hate Jane Austen, it’s easy to conclude that it's because they have no interest in the class consciousness, arch conversation, ballroom dances, and “marrying well” that constituted middle and upper-class Regency England. But how do we know that the real problem isn’t simply that they no longer have the tools to make sense of the subtle ironies, compelling characters, lively dialogue, suspenseful plots, and still-relevant commentaries on human nature of a writer who is as engaging and entertaining to those who give her a chance as she is dismissed by others as frivolous and irrelevant?

Do facilitated individuals have motor difficulties that explain away the concerns about FC?

(Cross-posted at FacilitatedCommunication.org).

Ever since Douglas Biklen began promoting facilitated communication in the 1990s, one of his central claims—and one of the central claims of other FC proponents—has been that autistic individuals have difficulty controlling their bodies. This, purportedly, includes difficulties with motor control and motor planning (e.g., with ten-finger typing) and with what I’ll call “intentional control”: the ability to inhibit one’s body from carrying out an unintended goal (e.g., inhibiting the urge to flap one’s hands or echo a favorite phrase) that would interfere with an intended goal (e.g., intentional communication).

The term “intentional control”, I should note, is my own coinage. It’s a workaround for the fact that proponents haven’t given us a precise term for the phenomenon in question. Sometimes they call it “praxis”—and then use “apraxia” for significantly impaired “praxis”. But, outside the FC world, “praxis” is consistently defined as motor planning: planning out a combination or series of motor movements. And, outside the FC world, “apraxia”—whether speech apraxia (difficulty making intended speech sounds), oromotor apraxia (difficulty with other oral movements like chewing and swallowing), or more general apraxia (difficulty performing intended or requested motor sequences like cutting out a requested shape)—is consistently defined as a significant difficulty with motor planning. That is, praxis/apraxia apply to situations where what’s at issue is whether someone has the motor planning skills to accurately carry out certain physical goals/commands (e.g., cutting out a triangle or saying the word “lickety-split”). Praxis/apraxia do not apply when what’s at issue is whether someone can inhibit other physical goals/urges (e.g., flapping their hands or echoing the word “popcorn”) that interfere with their primary goal (e.g., saying “thank you”).

So how does FC fit into all this?

The story goes as follows. Motor control difficulties are supposed to explain the inability to speak, the inability to type with ten fingers, and the need to have another person hold one’s wrist or elbow in order to keep one’s typing arm/index finger steady. Intentional control difficulties, meanwhile, are supposed to explain the fact that an autistic person’s spoken words or behavior are often at odds with what they type when subjected to facilitation. Think of the S2Ced person who says “No more! No more!” while typing about her feelings towards another person, or the RPMed person who, when asked what he wants for breakfast, refuses pancakes after he types pancakes.

Finally, some combination of motor control difficulties and intentional control difficulties are supposed to explain why the cognitive skills and language comprehension skills of facilitated individuals, as assessed in formal, unfacilitated settings, appear to be so much lower than the cognitive and linguistic levels displayed in their facilitated output. Think of the S2Ced individual who, when asked by an S2C professional what field alchemy turned into, can type “chemistry” onto a held-up letterboard , but who, when asked during a cognitive assessment to point to a green object, points to a red object instead.

So what is the evidence for motor control and intentional control challenges in autism? What is the evidence that autism is, as Biklen and others put it, a motor disorder, and not, as the DSM defines it, a disorder involving diminished social behaviors and elevated restrictive/repetitive behaviors?

In fact, new claims about evidence are made each time an article appears that reports data indicating motor difficulties in autism. Most recent are two articles by Bhat (2020 and 2021). Each of these—the two articles use the same database and draw similar conclusions—find evidence for motor difficulties in an overwhelming majority of children with autism (approximately 87%). The more recent article, Bhat (2021), also finds that the severity of motor difficulties correlates with autism symptom severity and degree of cognitive impairment.

These articles have, predictably, been a big hit with FC proponents. In a recent YouTube debate between three proponents of RPM and a behavioral analyst, one of the proponents, implicitly citing Bhat’s research, claims (between the 11:25 and 13:00 minute marks) that a “giant sampling of autistic people” has found that “86% of autistic people have clinically significant apraxia.” She adds that “a lot of people with apraxia have severe motor disinhibitions,” which, she says, means that

They do movements and things that they don’t intend to do. They make faces. They say things that they didn’t intend to say.

But do either of the Bhat articles actually draw such conclusions?

As it turns out, there are several problems with the claim that 86% (or 87%) of individuals with autism have a “clinically significant apraxia” that includes “motor disinhibitions”:

1.       Bhat’s data (drawn from the Simons Foundation’s SPARK database) was parent surveys (reliably unreliable), not clinical observations.

2.       Only some of the survey questions addressed praxis/motor planning; the others focused more on fine motor and gross motor skills.

3.       None of the survey questions addressed “motor disinhibition.”

4.       While Bhat discussed fine and gross motor impairments in her conclusions, she made no specific references in either of these conclusions to motor planning difficulties/apraxia.

Let’s take a closer look at Bhat’s survey questions. Bhat used the 2007 Developmental Coordination Disorder Questionnaire (DCDQ ’07). These questions probe skills like throwing, catching, and hitting a ball, jumping over obstacles, and various athletic skills (gross motor skills); and writing, drawing, and cutting skills (fine motor skills). None of these bear any obvious relationship to FC/RPM/S2C. They also probe motor planning skills like:

building a cardboard or cushion “fort,”  moving on playground equipment, building a house or a structure with blocks, or using craft material.

And:

[being] quick and competent in tidying up, putting on shoes, tying shoes, dressing, etc.

Nor do any of these questions address difficulties that align with claims made by FC proponents. There’s nothing here, for example, that probes difficulties with pointing—not least the sort of difficulty that would require the wrist or elbow support seen in traditional FC. Indeed, as far as I know, the only people who claim (without evidence) that individuals with autism have significant difficulties pointing to things are FC-supporters like Morton Gernsbacher. Either the complete absence in the DCDQ of questions about pointing is an egregious omission, or pointing, even among those with significant motor challenges, is not a common difficulty.

What about the claim that “a lot of people with apraxia have severe motor disinhibitions” and therefore “do movements and things that they don’t intend to do.” To some extent, this sounds reasonable: if you have difficulty throwing a ball or cutting a shape out of paper, the problem, in some sense, boils down to unintended movements. You threw the ball along a trajectory that you didn’t intend, or cut out a shape that doesn’t look like the shape you intended, because your arms or hands or fingers didn’t move the way you intended them to.  But none of this has any obvious relevance to FC/RPM/S2C.

What is relevant, on the other hand, is a second meaning of “do movements and things they don’t intend to do” that is artfully hidden behind the first. It goes back to my coinage of “intentional control”: the ability to inhibit one’s body from carrying out an unintended goal (e.g., inhibiting the urge to flap one’s hands or echo a favorite phrase) when it interferes with an intended goal. To some extent, this is a real phenomenon. Flapping (and other “stims”) and echolalia, both common in autism, are often reflexive rather than intentional. They can be difficult to suppress.

But FC proponents have more in mind than just this. To explain why what facilitated people type is so often at odds with their behavior—whether calling out “No more! No more!” or refusing pancakes—FC proponents have to include, as “movements they don’t intend to do,” much more than stims and echolalia. They also have to include actions that look pretty darn intentional to most of us. And these actions have to actively interfere with other acts that are intentional.

Consider the question about whether a child can construct a house out of blocks. A child with motor planning difficulties might build an amorphous object that doesn’t quite look like a house. A child with an “intentional control” problem—in the stronger sense of “intentional control” that FC proponents are cornered into believing in—might accidentally build a tower or an arch instead of a house. Or neatly print out the word “popcorn” when they meant to write “today”. Or clearly pronounce the word “dinosaur” when they meant to say “jacket.” Or point to the red square when they meant to point to the green one.

If all this sounds unlikely, it’s because it is. These are not instances of apraxia/motor planning. Nor do any of the articles on motor difficulties in autism describe anything that even comes close. The kind of mind-body disconnect that one would need to invoke—and that, indeed, FC proponents do invoke—is unattested in any empirical studies of autism.

Let’s climb down from these fantastical heights and conclude with a final claim about motor control—one that is especially popular with S2C supporters in particular. These folks claim that the reason that S2Ced individuals must rely on index-finger typing—as opposed to speech or ten-finger typing—is that they have significant problems with fine motor control. As Elizabeth Vosseller, the “inventor” of S2C, puts it:

We start by taking communication out of speech, and we teach purposeful movement by using the whole arm, taking it out of fine-motor, putting it in gross-motor…

To some extent, the Bhat papers support this strategy: Bhat finds significant difficulties with fine motor control in autism.

But there are two fatal problems. The first is that Bhat finds that difficulties with gross motor control in autism are nearly as prevalent and significant as difficulties with fine motor. The second is that pointing is a fine motor skill.

Indeed, in the YouTube debate, starting at around 14:00, the behavior analyst tries, repeatedly, to get this across—in part by demonstrating this by making pointing gestures at the screen. But the RPM proponents quickly dismiss him.  

One says: “No, when you have movement from shoulder, that’s gross. If movement comes from shoulder, it’s gross. If it’s from the wrist down only, then it’s fine motor.”

Another chimes in with “Nick, you’re using your shoulder right now. Nick, you’re using your shoulder right now.”

The first, perhaps noticing that Nick’s shoulder is hardly moving at all, adds “and your elbow… your whole arm.”

Nick says “I believe it’s just the bottom half of my arm that’s moving.” He then suggests that they move on to new topics.

But that doesn’t happen until the main speaker pauses and says “Ok. Anyway. That’s gross motor, that’s not debatable.”

Of course, the main reason why this isn’t debatable is that if, on top of autism not being a mind-body disconnect, pointing is not gross motor but fine motor, then one more critical foundation for S2C comes crashing down.

REFERENCES:

Bhat A. N. (2021). Motor Impairment Increases in Children With Autism Spectrum Disorder as a Function of Social Communication, Cognitive and Functional Impairment, Repetitive Behavior Severity, and Comorbid Diagnoses: A SPARK Study Report. Autism research : official journal of the International Society for Autism Research, 14(1), 202–219. https://doi.org/10.1002/aur.2453

Bhat A. N. (2020). Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study. Physical therapy, 100(4), 633–644.

Wilson, B.N., Crawford, S.G., Green, D., Roberts, G., Aylott, A., & Kaplan, B. (2009). Psychometric Properties of the Revised Developmental Coordination Disorder Questionnaire. Physical & Occupational Therapy in Pediatrics, 29(2):182-202. https://dcdq.ca/uploads/pdf/DCDQAdmin-Scoring-02-20-2012.pdf

Real-world problems with real-world projects

I've long had reservations about the real-world projects that much of the edworld is infatuated with. They often detract from time spent on foundational content and basic skills. They often involve a large ratio of effort/time to learning (with time lost to travel, assembly, and other logistics). They often don't match the actual real-world demands that students need to meet upon graduating. And, to the extent that they do, they are perhaps better learned completely outside the academic setting--i.e., out in the real world. Let the academic courses focus on what they're most suited to: generalized content and basic skills.

But a more practical downside to real-world projects has also occurred to me: they're much easier than traditional assignments are to fake. No one's looking; no one's checking to see if the real world is as you say it is, or whether you actually went out and did what you said you did in it. Does the classroom or clinic you observed actually exist? Are the people you interviewed real people? Did you actually conduct the experiment you wrote up and drew diagrams for? Are the results you reported ones you actually got, or merely ones you were hoping for?

Of course, similar questions apply out in the real world--as the field of psychology has recently discovered. Perhaps other fields will follow suit.

More maps, fewer portraits

If you rewound history and let it play out again, the individuals would change; the geopolitics, less so.

And so I've always felt that history texts can never have enough maps. 

Especially given how cartographically challenged so many American students are.

So in place of a "Picturing History" portrait of Zebulon Pike

...why not a map showing--all at once--the Louisiana Purchase and the paths of the Lewis and Clark and the Pike Expeditions, complete with rivers and mountains. Something like:

This would seem a more relevant way to picture history than what exactly Pike may have looked like in his officer's uniform with his soldiers in the background.

Of course, students can always "look it up on the Internet," as I did (expending all of about two seconds). But, in the age of mapless navigation and shrinking cartographic literacy, how many will be inspired enough, and motivated enough, to bother?

Even when you do have maps, opportunities are missed. Notice here how the "Geography Skills" textbox completely obscures the Suez Canal: