Facilitated communication.

Abstract

To the Editor. Hostler's commentary1 on facilitated communication (FC) constructs a one-sided report of a very complex communication method for people with severe disabilities. We will limit our comments to the major points of Hostler's commentary.First, while it is correct that FC was developed in Australia by educator Rosemary Crossley,23 it was independently discovered in Denmark, Sweden, Canada, England, Germany, Japan, and the United States.4-8Second, FC became embroiled in controversy when some previously nonspeaking children and adults purportedly used facilitation to make allegations of sexual abuse against family members, care givers, and others. A legal authority in Australia has researched the issues related to use of FC in the courtroom, and provides evidence that contradicts evidence in the case Hostler cites and outlines the conditions under which facilitation has been admitted to Australian, American, and New Zealand courtrooms. In the United States, the Kansas Supreme Court10 upheld a conviction based on FC; in another case an adolescent girl first made her allegation of abuse with facilitation and subsequently achieved independent typing to confirm the allegation.11 Of particular note on this topic is the one retrospective study by a medical team of allegations made via facilitation.12 Botash et al12 concluded that in abuse cases that were alleged through FC “the indication rate for abuse and neglect is consistent with the upstate New York rate (where the study took place) of approximately 47%, which “demonstrates that allegations of abuse that are initiated owing to an FC disclosure should be taken seriously.” Recent legal analyses have suggested procedures for implementing such a policy.13-16Third, while leading proponents of the method have urged practitioners to separate testing the method from the teaching of the method,17 they have actively supported evaluating the method under natural and controlled conditions and have themselves been involved in and/or supervised such research.218-24 And, at least one major communication center has successfully combined teaching of the method with testing for authorship.25Virtually every account of facilitation has noted that facilitators can easily influence the communication produced.21426 This is the major reason for developing tests of individuals' abilities to communicate their own words with facilitation or of teaching FC users to achieve independent typing.2027Research on the method demonstrates that FC varies greatly from student to student in terms of spelling (phonetic and creative spelling), grammar, use of stereotyped and archaic/formalistic phrases, unique definitions, problems in understanding, frequency of word usage, and length of utterances.28-29Numerous, recent, controlled investigations of facilitation have confirmed that under certain test conditions, some—in some studies it is the majority—FC users are able to prove they are the ones communicating, not their facilitators. The studies include reproduction of words that the subject and not the facilitator has seen,24 message passing from stories read to subjects but not facilitators,2230 instances of subjects playing sophisticated computer games via facilitation, but with the facilitator blocked from seeing the content on the screen,31 and naming of pictures.32In each of these studies, individuals had numerous practice sessions and multiple test sessions. This contrasts markedly with those studies in which none of the participants have succeeded with validating their authorship.2633 Test protocols make a difference in whether or not individuals with autism and other disabilities will succeed in demonstrating communication competence.