Abstract
A popular treatment in many countries in the world threatens the communication rights of autistic non-speakers, argues
If you’re tuned into the world of neurodiversity, you might think you know exactly what this is. The constant prompting, the forced compliance, the dismissing of off-task behaviours - this, surely, is Applied Behavioural Analysis, the standard intervention for autism. Indeed, it’s all that is wrong with ABA. It’s why, for many neurodiversity proponents, ABA is the bete noire of autism interventions.
ABA was originally designed for mitigating behaviours like tantrums and eating irregularitites as well as teaching basic skills like vocabulary, while in its later application to autism, studies show it boosts communication skills and adaptive functioning. But it has been criticised on several counts: for falling far short of early claims of “curing” autism and for attempting to inflict such a cure; for its intensity - 20 to 40 hours per week; for its drills and reinforcements, which some compare to dog training; and finally, despite its shift from more coercive table-top settings towards more natural, play-oriented settings, for causing PTSD.
But the boxed-in child never gets to tell the world about the far more traumatic intervention they’re being put through. That’s because this intervention doesn’t teach communication. Rather, it simultaneously suppresses communication and hijacks it.
The intervention is facilitated communication (FC). Its basic elements are a facilitator who holds the wrist or forearm of a non-speaker while the non-speaker points to letters on a keyboard. That’s the version of FC that became popular in the late 1980s around the world but particularly in English-speaking countries, and especially with autistic non-speakers.
By the late 1990s, dozens of studies showed that it was the facilitator who controlled the messages. When the facilitator was shown a picture of a flower while the non-speaker was simultaneously (unbeknown to the facilitator) shown a key, what was typed out was not “k-e-y”, but “f-l-o-w-e-r”.
In test after test, the correct answer was typed only when the facilitator knew the answer. The facilitator, it turned out, was unwittingly cueing the letter selections through non-conscious muscle movements that arise through a psychological effect known as the ideomotor phenomenon. When some of these early facilitators discovered what was happening, they were shocked and abandoned the process.
But FC stuck around. Desperate parents continued to resort to it, those who spoke out against it were (and are) accused of ableist skepticism and it assumed subtle new forms. Over time, those subjected to it become (subconsciously) sensitised to increasingly subtle (non-conscious) facilitator-generated muscle movements. Wrist holds evolved into pressure on shoulders or thighs; and unintentional auditory or visual cues (vocalisations, gestures) replaced tactile cues.
To naive eyes, it sometimes looks as though all the facilitator is doing is sitting next to a person and watching them type. Yet dozens of studies from the 1990s consistently found that if the facilitator leaves the room or doesn’t know the answers, that person is unable to produce appropriate, spontaneous responses - especially ones containing the well-formed sentences and perfectly-spelled vocabulary that he or she produces when the facilitator is present and knows what the response should be.
Complicating matters, novel forms of FC have appeared, marketed as something completely different. By 2003, we had Rapid Prompting Method (RPM) and by 2015, Spelling to Communicate (S2C). These methods don’t look like FC. Instead of holding the person’s hand, the facilitator holds up a letterboard. Instead of unconsciously cueing with muscle pressure, the facilitator unconsciously moves the letterboard, reducing the distance between the targeted letter and the person’s extended finger.
A therapist works with an autistic child on recognition and writing of letters on a keyboard in Korb, Germany, 2017
CREDIT: Sebastian Gollnow/dpa/Alamy Live News
In short excerpts, RPM and S2C look a lot less coercive than “classic” FC. And, as promoters will tell you, there is no research showing them to be invalid. But that’s partly because no practitioners have agreed to rigorous testing and/or to the publication of the results, as is reflected in the absence of any published studies. Yet half a dozen published, informal tests, including several described in the pro-RPM memoir Strange Son, have shown facilitators to be the ones controlling the messages.
RPM and S2C facilitators compensate for their lack of immediate control (as compared with the classic facilitator’s direct contact with the typing arm) by determining letter selection in other ways. As we see in the 2023 pro-S2C documentary Spellers, they decide when and what has been selected, routinely ignoring or dismissing “incorrect” choices or misreading which letter was typed. They whisk the board away when typing goes awry, and when they bring it back, it’s often with the target letter in front of the pointing finger.
Tellingly, not once do we see facilitators letting autistic individuals take ownership of the letterboards - videos show people attempting to hold boards only to have their facilitator remove it. Instead, the boards are controlled by facilitators, as are the autistic people themselves - their cries of protest (“No more! No more!” or “I’m sad. I want Mama”) are often ignored.
Many are able to communicate independently. The problem for facilitators is that their words and gestures often clash with the messages they are being directed to type, as I write about in detail on the site Facilitated Communication. How can someone talk about how S2C allowed her to express her true feelings while simultaneously protesting “No more! No more!”?
Anecdotal reports, including by a pro-S2C parent, suggest some practitioners actively discourage speech. Speech, of course, is a lot harder for facilitators to control than single-finger typing. So speech, particularly speech made in protest, is silenced or ignored, while alternative messages, including messages that negate those protests, are forced out and falsely attributed. The rights violations are appalling.
But with ABA falling short of its early promises, and with no other evidence-based therapy endowing minimally-speaking autistic individuals with the communication capacities that parents crave, FC offers hope.
Meanwhile, the public is fed a steady diet of feelgood, FC-promoting news stories and films that win over yet more converts - obscuring the terrible costs to some of the most vulnerable people.