In two recent posts, I discussed what we know about motor difficulties, intentional control difficulties, and apraxia in autism. As we saw, such difficulties neither justify the need for FC, nor explain why facilitated individuals (a) sometimes pronounce words that are at odds with their facilitated typing and (b) demonstrate cognitive skills during neuropsychological evaluations that are well below the cognitive skills they show when they’re being facilitated.
To recap:
There is no empirical evidence that the motor difficulties in autism include difficulties with pointing.
Language assessments that prompt autistic individuals with motor difficulties to point to things, therefore, do not underestimate their receptive language skills.
Apraxia of speech (AOS) cannot be diagnosed in minimal speakers: AOS involves difficulty consistently producing combinations of vowels and consonants, and the smaller a child’s consonant and vowel repertoire, the harder it is to detect these difficulties and inconsistencies.
There is no evidence of a “motor disinhibition” problem in autism (or in any other condition) that causes people to point to item A when they want to point to item B, to say the word “yes” when they intend to say “no”, to throw random objects instead of cleaning up, or to follow a multi-step procedure unless they type it out first.
In autism, gross motor problems are about as prevalent as fine motor problems, so converting a fine motor task into a gross motor task does not, as a general rule, result in a more accessible, autism-friendly task.
Pointing is fine motor, not gross motor.
In this post, I’ll say one more thing pertaining to motor difficulties, and then I’ll turn to two other autism-related challenges that are supposed to explain away some of the concerns about FC: echolalia and word-retrieval difficulties.
The “one more thing” is a new set of findings that was presented this month at the annual INSAR (International Society for Autism Research) conference by Dr. Yanru Chen, a postdoctoral associate at Boston University’s Department of Psychological and Brain Sciences. Chen’s team looked at a sample of 1579 minimally speaking autistic children drawn from two large-scale research databases. They found that minimally speaking autistic children had much lower receptive language skills (comprehension skills) compared to their neurotypical peers, that this gap widened with age, and that receptive language skills correlated with social skills (and thus, inasmuch as social deficits are a core symptom of autism, that receptive language skills correlated with autism severity).
They also found, however, that there exists a subset of minimal speakers (about 25%) in which receptive language skills are relatively high relative to expressive skills (e.g., speaking skills). And if you’re an FC supporter, you might now be thinking:
Ah hah! This validates what’s going on with non-speakers who can type out “herbivore” or “amber” on a held-up letterboard in answer to questions about the opposite of carnivore or the name for fossilized tree resin.
However, as Chen et al’s presentation adds, the receptive language skills even of this unusual subgroup:
are still lower than those of non-autistic individuals
are positively associated with motor skills.
That is, as Chen puts it:
[I]n this subgroup, motor skills emerge as the only significant factor predicting the discrepancies between receptive and expressive language above and beyond all other factors. And those with better motor skills are more likely to have much better receptive language than expressive language.
What this means is that those who are supposedly most in need of FC—i.e., because of their purported motor difficulties—also have the worst receptive language skills… And that it’s unlikely that people who rely on FC/RPM/S2C know the meanings of words like “carnivore” and “amber” when they type them.
Now let’s turn to claims about reflexive language and echolalia. These claims, going back decades, are supposed to explain what’s going on with people who say “Popcorn! Popcorn” while conversing through FC about the nature of language, or people who say “No more! No more!” while describing a close relationship. Such spoken utterances are routinely dismissed by FC proponents as meaningless, reflexive uses of language—as opposed to the FCed messages, which are, purportedly, authentic communication.
What is the evidence for meaningless, reflexive uses of language in autism? The best candidate is echolalia. Echolalia, indeed, is sometimes considered merely reflexive. But it is often considered meaningful, as when a child echoes someone else’s “Do you want a cookie?” as a request for a cookie (Kim et al., 2014; Xie et al., 2023). Prizant and Rydell (1984), analyzing the role of delayed echolalia in 3 autistic individuals, enumerated a host of purposeful uses, including self-direction, labeling, turn-taking, providing information, affirming, request, protesting, directing, and rehearsing (repeating something in order to keep it in memory). In the only study I’ve encountered that suggests that echolalia is merely reflexive, it occurs as an immediate echo of whatever was last said (Grossi et al., 2013). But, in the context of FC, “Popcorn! Popcorn!” and “No more! No more!” are not immediate echoes of what was just said.
Another possibility is that “Popcorn! Popcorn!”, “No more! No more!”, along with other spoken utterances that clash with the FCed messages they coincide with, are verbal perseverations. Temple Grandin, for example, reports shouting out the “prosecution” because she liked how it sounded. Another child might repeat “You must not hit” as a way to regulate his behavior (Wevrick, 1986). But deliberately repeating something to fulfill a conscious goal is different from echoing words as a non-deliberate reflex. Saying something deliberately should interfere with your ability to simultaneously type out an unrelated message: give it a try and see what happens! It ought to interfere, that is, unless you’re not the one directing your typing.
Finally, let’s turn to word-retrieval difficulties. These are supposed to explain both the need for prompting and the failure of FC during message-passing tests. Prompting purportedly helps the person retrieve words they might not be able to retrieve in a timely fashion on their own. And message passing tests supposedly involve stressful environments that aggravate word-retrieval difficulties, such that these difficulties are what cause message-passing failures. (Somehow those being facilitated have consistent word-retrieval difficulties only when testers ask them to identify a picture or object that their facilitators weren’t shown, and somehow those word-retrieval difficulties can occasionally cause the facilitated person to type out what the facilitator saw instead of what they saw).
But while there is some evidence that autistic individuals are slower to retrieve words than their non-autistic counterparts, (see Hartley et al., 2020), there’s no evidence for higher rates of word retrieval failure in autism. In addition, as Jacobson et al. (1995) and Vázquez (1995) point out, when people fail to retrieve words, they compensate via circumlocution. That is, if you can’t call up the word “key”, you might say “thing that goes in a lock.” Such circumlocutions, Jacobson et al. add, have almost never occurred during message-passing tests.
Thus, when an individual with autism is unable to name or describe an object, the most likely explanation is that they don’t know the relevant words, not that they can’t retrieve them. (And, if what’s going on is a message-passing test, that their facilitator is the one directing the messages).
To recap:
Most minimal speakers, including those with the greatest motor control difficulties, have limited receptive language skills. This undermines claims that FC unlocks significant language skills that are locked in by motor difficulties.
When a facilitated person speaks words that clash with what they’re simultaneously typing, those utterances are most likely deliberate and should interfere with the typing process, assuming the typing is independent.
Word-retrieval difficulties in autism do not explain away message-passing failures.
REFERENCES:
Grossi, D., Marcone, R., Cinquegrana, T., & Gallucci, M. (2013). On the differential nature of induced and incidental echolalia in autism. Journal of intellectual disability research : JIDR, 57(10), 903–912. https://doi.org/10.1111/j.1365-2788.2012.01579.x
Hartley, C., Bird, L. A., & Monaghan, P. (2020). Comparing cross-situational word learning, retention, and generalisation in children with autism and typical development. Cognition, 200, 104265. https://doi.org/10.1016/j.cognition.2020.104265
Jacobson, J. W., Mulick, J. A., & Schwartz, A. A. (1995). A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication. American Psychologist, 50(9), 750–765. https://doi.org/10.1037/0003-066X.50.9.750
Kim, S. H., Paul, R., Tager-Flusberg, H., & Lord, C. (2014). Language and communication in autism. In F. Volkmar, R. Paul, S. J. Rogers, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders (4th ed., Vol. 1, pp. 232–363). Wiley., doi:10.1002/9781118911389.hautc10
Prizant, B. M., & Rydell, P. J. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of speech and hearing research, 27(2), 183–192. https://doi.org/10.1044/jshr.2702.183
Vázquez C. A. (1995). Failure to confirm the word-retrieval problem hypothesis in facilitated communication. Journal of autism and developmental disorders, 25(6), 597–610. https://doi.org/10.1007/BF02178190
Wevrick, P. (1986). The Role of Echolalia in Children with Various Disorders. Canadian Journal of Speech-Language Pathology and Audiology.
Xie, F., Pascual, E., & Oakley, T. (2023). Functional echolalia in autism speech: Verbal formulae and repeated prior utterances as communicative and cognitive strategies. Frontiers in psychology, 14, 1010615. https://doi.org/10.3389/fpsyg.2023.1010615
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