(Cross-posted at FacilitatedCommuniction.org.)
In a recent post, I critiqued the curious “facts” listed on United for Communication Choice (UCC)’s facts page. In what may be my final post on UCC, I’ll now take a look at the two most recent articles listed on its research page.
What distinguishes UCC from all other pro-FC websites is its compilation of all (or nearly all) the pro-FC, peer-reviewed publications out there—or at least publications that look peer-reviewed and can be interpreted by at least some FC proponents as FC-friendly. In all, it lists around 175 publications. We at FacilitatedCommunication.com have gone through them all and have included most of what are purportedly the more FC-friendly articles, along with our commentary, in the Research section of this website. We’ve also critiqued some of the most FC-friendly (or purportedly FC-friendly) articles in more detail here in the blog section. But before I add two more articles to that last, I want to place them in their broader context relative to UCC.
UCC’s raison-d’être appears to have been the pending 2018 position statements of the American Speech-Language-Hearing Association (ASHA) against FC and its variants (Rapid Prompting Method or RPM; Spelling to Communicate or S2C). Indeed, another page on its website contains a compilation of about 130 letters written to ASHA in 2018 urging it to reconsider these statements. Included are letters by parents of individuals who are subjected to FC, RPM, and S2C; letters generated via FC, RPM, and S2C; and letters by such luminaries as Elizabeth Vosseller, who re-branded RPM as S2C; Vaishnavy Sarathy of the S2C documercial Spellers; and veteran autism echolalia expert Barry Prizant. But five years have passed since ASHA’s position statements, and ASHA (thankfully) hasn’t caved.
Perhaps this explains the lack of recent additions to UCC’s research page. Some of its listings date back to the 1990s; the overwhelming are from 2000 onwards. But there’s been nothing since 2022, and only two from 2022: the two articles to which I now turn.
One of these is Heyworth et al. (2022). It reviews the research for and against FC and, in the words of the abstract, “argue[s] that the current dismissal of FC is rooted in ableist and outdated approaches.” As I argued in my critique of this article Evidence-Based Communication Assessment and Intervention, the authors base their argument on:
[I]naccurate assumptions about augmentative and alternative communication (AAC), Applied Behavior Analysis (ABA), conversational pragmatics, message passing tests, cognitive testing, cueing, recent discoveries about autism, and/or the empirical research on FC.
I also explain how the authors depend on circular reasoning (FCed messages that are cited as evidence that FCed messages are valid), claims that are not supported by the studies cited as support, “biased characterizations of FC critics,” and “biased takes on key concepts pertaining to FC and the rights of people with disabilities.” If you’re interested in accessing this paper and are unable to do through an academic institution, please let me know.
The final paper to appear on UCC’s research page is a paper entitled “Gross Motor Impairment and Its Relation to Social Skills in Autism Spectrum Disorder: A Systematic Review and Two Meta-analyses” (Wang et al., 2022). Though this paper is less obviously FC-friendly than Heyworth et al., any paper that appears to support the notion that autism is a motor disorder can be construed as FC-friendly. As Douglas Biklen realized back in 1989 when he first observed FC in Australia and then introduced it to the U.S., redefining autism as some sort of motor disorder instead of a disorder involving impaired communication serves two FC-friendly purposes. It accounts for the sophisticated communicative content of FCed messages, and it explains the need for the physical support for typing that is provided by facilitators.
On closer inspection, however, Wang et al. is not as FC-friendly as proponents might hope. On one hand, “aggregating data from 114 studies representing 6,423 autistic and 2,941 NT individuals,” the researchers establish, in their first meta-analysis, that there is a “significant overall deficit in gross motor skills in ASD.” But since typing is a fine motor skill, difficulties with gross motor skills do not explain the need for facilitation during typing. Unless, that is, one were to argue, as Nicoli et al. (2023) do, that facilitation addresses gross motor difficulties. Nicoli et al.’s paper, which I critiqued in a previous post, argues that tactile feedback from facilitators might help facilitated individuals with postural control—a gross motor function—during facilitation. The idea is that difficulty with postural control is so distracting for autistic non-speakers that they are unable to communicate by typing. Unless, of course, they are facilitated.
Setting aside the serious flaws in Nicoli et al. that I critiqued earlier, there’s another problem with the gross motor justification for facilitation: namely, findings from Wang et al.’s second meta-analysis. This one, “synthesizing data from 21 studies representing 654 autistic individuals,” found “a modest but significant overall correlation between gross motor and social skills in ASD.” UCC, excerpting this statement, seems to consider it an FC-friendly finding. In some sense it is: as Wang et al. point out, since social deficits are considered core symptoms of autism, a correlation of gross motor deficits with social deficits lends some support to the idea that motor deficits could be considered core symptoms as well. Indeed, if gross motor deficits turn out to be the underlying causes of social deficits, then gross motor deficits could replace social deficits as core symptom for autism.
As possible ways in which gross motor deficits could cause social deficits, the authors propose that these:
could contribute to the development of social impairment over time by altering the ways in which autistic individuals perceive and interact with others. Early changes in posture and locomotion have been tied to changes in the social information that children see… and the frequency and quality of their social interactions… and may thereby alter children’s opportunities for social learning… [M]otor coordination may also affect the quality of social interaction... For instance, deficits in basic motor skills may constrain interpersonal coordination of movements during social interaction… [S]chool-age children with poorer motor coordination skills participate in fewer activities, engage in less social play, and choose more socially isolated activities than those with more advanced coordination skills.
But they also note:
[T]he converse relationship may also be true, such that social deficits contribute to the development of gross motor impairment… Early social differences associated with ASD may limit children’s participation in activities that would otherwise allow them to practice gross motor skills.
In addition:
Another possible explanation is that the association between gross motor and social deficits in ASD is the result of common neurobiological mechanisms (such that social deficits and motor deficits are expression of a common source), rather than direct causal effects of one domain on another.
As the authors conclude, “Further research is needed to test the causality and directionality of this relationship.”
But even if gross motor deficits were to replace social deficits as defining symptoms of autism, there’s still a huge problem for FC: namely, the correlation between the degree of social difficulties and the degree of gross motor difficulties. That correlation rules out the possibility of claiming, as Biklen did, that autism only involves motor difficulties, and not communication difficulties. Gross motor problems that are significant enough to warrant facilitation are also significant enough to entail significant social difficulties. Those social difficulties, in turn, would undermine both the acquisition of language (see our discussion here), and the social use of language that is the basis for effective communication. In particular, it would undermine the communication skills that are prerequisite for all those FCed messages that, proponents claim, are somehow authored by those with significant motor impairments—for example (to cite just one of hundreds of examples), “The irony of a nonspeaking autistic encouraging you to use your voice is not lost on me.”
The connection of gross motor deficits, via social deficits, to language and communication deficits recalls another paper I discussed in an earlier post—namely, findings by Yanru Chen, presented at this year’s INSAR conference and described in the INSAR’s Autism Research Review International, about the small subgroup of minimal speakers who have larger-than-expected receptive language skills (comprehension skills) given their minimal expressive language skills (speaking skills). In this subgroup:
[M]otor 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.
Thus, the degree of motor skills deficits correlates not just with the degree of social skills deficits, but also the degree of the deficits in language comprehension. And given that you can’t be the author of a message that uses words you don’t understand, the degree of motor skills deficits also correlates with the how plausible it is that a particular autistic individual was the author of a particular message that was FCed out of him. The greater his or her motor skills deficits, the less likely he or she is to be the true author. At least, that’s what the research—including the purportedly FC-friendly research—is telling us.
REFERENCES:
Beals, K. P. (2022) Why we should not presume competence and reframe facilitated communication: a critique of Heyworth, Chan & Lawson, Evidence-Based Communication Assessment and Intervention, 16:2, 66-76, DOI: 10.1080/17489539.2022.2097872
Chen, Y. (2023). Nonverbal kids with ASD may understand much more language than they produce. Autism Research Review International, Vol. 37, No. 2, 2023.
Heyworth, M., Chan, T., & Lawson, W. (2022), Perspective: Presuming Autistic Communication Competence and Reframing Facilitated Communication, Frontiers in Psychology, 13:864991
Nicoli G, Pavon G, Grayson A, Emerson A and Mitra S (2023) Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities. Frontiers in Integrative Neuroscience 17:1181025. doi: 10.3389/fnint.2023.1181025
Stone, W. L., & Yoder, P. J. (2001). Predicting spoken language level in children with autism spectrum disorders. Autism : the international journal of research and practice, 5(4), 341–361. https://doi.org/10.1177/1362361301005004002
Wang, L. A. L., Petrulla, V., Zampella, C. J., Waller, R., & Schultz, R. T. (2022). Gross motor impairment and its relation to social skills in autism spectrum disorder: A systematic review and two meta-analyses. Psychological bulletin, 148(3-4), 273–300. https://doi.org/10.1037/bul0000358
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