Cross posted at FacilitatedCommunication.org.
I recently stumbled upon the “facts” page of the pro-FC organization United For Communication Choice and decided an annotated critique was in order. United for Communication Choice appears not to have conducted much activity on its site or elsewhere in the last year, but for a while it kept up a repository of pro-FC research, much of which we’ve critiqued here. In addition, it was a hub for criticism of a position statement against FC by the American Speech Language Hearing Association (ASHA), and many of its “facts” are inspired by that position statement.
In what follows, I excerpt the most problematic of these purported facts (preserving the original boldface type and links) and insert my critiques below them in italics.
“Fact” 1: “Many people wrongly assume people who cannot speak are incapable of complex thought and language.
Critique: It is well known that those who can’t speak because of motor problems can have normal-to-superior intelligence, particularly because of famous examples of this like Stephen Hawking. But non-speaking in autism is primarily a function, not of motor problems, but of diminished attention to voices and mouths, diminished joint attention behaviors, and associated intellectual impairment (See the DSM-5 and this post).
“Fact” 2: “In fact, all standard assessments of intelligence require the subject to either speak or move parts of their body in a controlled, volitional fashion. Several studies have demonstrated these assessments are inaccurate in measuring the intelligence of most non-speaking or unreliably-speaking individuals.”
Critique: All psychological tests, trivially, solicit responses. All responses, trivially, require volitional, physical responses. Only tests that peer directly into brains can bypass brain-external responses that are visible to observers. The key, in measuring intelligence autism, isn’t bypassing motor demands, but bypassing linguistic demands (except, of course, when the goal is to measure linguistic skills, which are a key component of cognition). As one of the “several studies” alluded to here shows (Courchesne et al., 2015), tests that minimize verbal demands, like the Ravens Matrices tests, are, indeed, more accessible to autistic individuals with verbal impairments, and such individuals do better on these tests. (I’ve seen this first hand with my own son). The other two of the “several studies” are irrelevant: one is a highly flawed, FC-promoting eye-tracking study, critiqued here and here, and the other is a review about what is currently known about the efficacy of Augmentative and Alternative Communication (AAC devices). Neither reports any new evidence about the accuracy of standard assessments.
“Fact” 3: There is no anatomical basis for assuming non-speaking individuals are “non-thinking”; speech and language are processed in different parts of the brain. Assuming that an individual with impaired speech has impaired language or lacks the intelligence to produce complex communication is neither appropriate nor “evidence-based.”
Critique: Speech is a component of language. Speech and non-speech components of language are processed in overlapping parts of the brain. Speech is processed in the motor cortex in an area known as Broca’s area. Broca’s area is also involved in the production of syntactically well-formed sentences and in sentence-level comprehension. Abnormalities in Broca’s area, therefore, can affect both speech and language.
“Fact” 4: A substantial body of research also indicates that autism is fundamentally characterized by motoric and sensory differences. One recent study found that nearly two-thirds of autistic children have a motor planning disorder called apraxia (Tierney et al., 2015). Non-speaking and unreliably-speaking autistic individuals are generally unable to speak because of motor issues, not cognitive ones.
Critique: These claims are supported neither by the diagnostic criteria for autism, nor, as we have discussed here and here, by the research on motor challenges in autism. And, naming only motor and cognitive factors, they ignore the factor most relevant to non-speaking in autism: core autism symptomology and the tendency, as a function of autism symptom severity, not to tune into social stimuli like voices and faces.
“Fact” 5: Most non-speaking individuals who are learning to type have tried—usually for years—a variety of other AAC methods, including, for example, PECS, PODD, or iPad/tablet-based variations like Speak for Yourself, LAMP, and Proloquo2Go. Many users of such programs have expressed frustration at the limited vocabulary available to them, especially during the early stages of training. Moreover, these types of AAC require extensive training and customization to enable the user to communicate truly fluently—for instance to compose poetry, tell a made-up joke, take AP Chemistry, or write an op-ed about gerrymandering.
Critique: The phrase “other AAC methods” implies that FC and its variants (RPM and S2C) are forms of AAC. They aren’t. The crucial difference is that AAC is used for independent communication, free of facilitator control over messages. Most AAC devices, including those mentioned here, include alphabetic keyboards, and so do not limit users in the ways claimed above.
“Fact” 6: Virtually all other forms of AAC are taught with a heavy reliance on prompting, and the use of trained communication partners who model, correct, and otherwise support the AAC learner.
Critique: In evidence-based AAC use, this prompting, modeling, and correction of device use (how to navigate the screen; which buttons to select) occurs during the teaching phase: the phase in which a new user is being taught how to use the AAC device. Under best practices, such prompting, modeling, and correction does not occur during the communication phase: the post-teaching phase in which the user is using the device to communicate. Even during the teaching phase, moreover, the goal is to fade cues as soon as possible.
“Fact” 7: Many non-speaking people will require various kinds of support throughout their lives; some prefer that. While many individuals with significant support needs prioritize independence, others have prioritized goals of greater interdependence rather than independence.
Critique: It’s hard to know what non-speaking people prefer when their preferences are expressed through facilitated messages—i.e., messages that are controlled by the facilitator.
“Fact” 8: The failure of many individuals to succeed on so-called “message passing tests” is interesting, but message passing tests are not the only kind of evidence available to determine whether people can communicate effectively using a keyboard or letterboard.
Critique: A message-passing test—a test in which the facilitator is blinded to what the appropriate letter selections are (i.e., because she hasn’t seen the picture the facilitated person is being asked to describe, or because she is wearing a blindfold and can’t see the letterboard)—are the only ways to ensure that facilitators aren’t (however unwittingly) cueing the typers about which letters to select.
“Fact” 9: There is incontrovertible evidence that non-speaking and unreliably-speaking individuals have learned, through painstaking practice with FC or RPM over many years, to communicate independently by typing. To see video examples of some of these individuals, click here.
Critique: As you can see if you follow the above link and watch the assorted videos, there are no examples here of truly independent typing. In all the cases, that is, there is always someone in auditory or visual cueing range of the typer. The unanswered question is what happens when that someone—who is often euphemized as a “communication partner’’—walks out of the room, such the individual they purportedly “assist” is completely free of their control.
REFERENCES
Courchesne, V., Meilleur, A.-A.S., Poulin-Lord, M.-P., Dawson, M., & Soulières, I. (2015). Autistic children at risk of being underestimated: school-based pilot study of a strength-informed assessment. Molecular Autism, 6:12
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