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Facilitated communication studies

(CNN) -- Below are summaries of selected studies on facilitated communication compiled by CNN.

Bebko, J., Perry, A., & Bryson, S. (1996). Multiple method validation study of facilitated communication: ii. individual differences and subgroup results. Journal of Autism and Developmental Disabilities, 26, 19-42.

"Potential individual variations in the effectiveness of a shared communication method, facilitated communication (FC), were examined among 20 students with autism and related disorders" (p. 19) who were the students of a regional program specializing in autism, ranging in age from 6 to 21 years. Sixteen staff members at the program who received "a typical 2-day FC training program" (p. 22) served as facilitators. Data collection began "after staff training and 11/2 months of using FC" (p. 26). "To minimize the limits or disadvantages of a single method, we used multiple methods, including auditory or visual input, and simple pointing response to pictures or words, as well as typing" (p. 19)

"Findings differed across methods, but there was little clear support for the validity of FC in enhancing communication over communication that students produced independently. Significant facilitator influence of responses was found, but was far less extensive than in other studies" (p. 20). Especially in the Headphones design, in which "the task for students...was simply to point with facilitation to the one of three pictures...which corresponded to a word presented auditorily through a small desk-top speaker" (p. 25), "less evidence of facilitator influence was found" (p. 33). A further analysis of students' responses under this design "demonstrated clearly that for all but Student 19 either the students were determining the response being made...or that responses were essentially randomly distributed among the alternatives available, either case indicating no facilitator influence (p. 34). "However, an 'abdication' pattern of responding was found for some students, in which high performance observed with independent responding was lessened on trials when FC was introduced" (p. 20).

Broderick, A. A. & Kasa-Hendrickson, C. (2001). "Say just one word at first": the emergence of reliable speech in a student labeled with autism. Journal of the Association for Persons with Severe Handicaps, 26, 13-24.

"This article presents a qualitative, interpretivist research study that documents the emergence, in the context of typed expression, of increasingly useful and reliable speech for a young person labeled with autism" (13).

"Jamie has maintained his desire to integrate speech with his typing, and is committed to pursuing this difficult work, in spite of the ambivalence he feels about the ways that his speaking affects others' perceptions of him. Jamie has been supported in this process by his family's and his teachers' consistently high expectations of him and their ongoing encouragement of and confidence in Jamie as a learner" (23).

"Jamie's experience presents a challenge to us as researchers, theoreticians, and educators to broaden the theoretical and conceptual frameworks that we use in order to account for the complexity of this young man's experience. We are challenged to account for Jamie's experience by understanding it not as a model, nor as an exceptional or anomalous case, but as a vision of possibility that may illuminate the experiences of others whose language development falls outside of our current conceptual models" (23).

Bomba, C., O'Donnell, L., Markowitz, C., & Holmes, D. (1996). Evaluating the impact of facilitated communication on the communicative competence of fourteen students with autism, Journal of Autism and Developmental Disorders, 26, 43-58.

"The purpose of this study was to evaluate facilitated communication (FC) as an augmentative or alternative communication system for 14 students attending the Eden Institute" (p. 43) - "a behaviourally oriented, educational program serving students with autism ages 3 to 21" (p. 46). Three facilitators, "who had at least 2 year's experience working with students with autism" (p. 48), were involved in the study. Two of them "received training in facilitated communication by attending a training workshop conducted by Schubert (1992) of Syracuse, NY" (p. 48) and the other was trained by one of these two.

Using both a standardized vocabulary test and a "protocol of 30 questions designed specifically for this study" (p. 49), a pretest was administered to all participants. The protocol contained questions "whose answers are objective and presumably known to both the facilitator and participant" such as Yes/No questions, object labeling, and simple personal questions (e.g., What is your name?), as well as "those that encouraged open-ended conversation" (p. 49) such as "How do you feel about your parents?" and "How do you feel about being autistic?" (p. 56). Following the pretest, "each participant received 10 weeks of individualized, daily instruction in FC" that "lasted a minimum of 5 minutes and a maximum of 25 minutes" (p. 51). Finally, "[a]t the conclusion of the instructional condition, the pretest was readministered as a posttest" (p. 51).

"For 13 of the 14 participants, pre- and posttest results were identical; no items were answered correctly" (p. 53) for both the vocabulary test items and the protocol question items, revealing that "10 weeks of instruction in FC did not significantly improve the participants' ability to use this system" (p. 53).

Cardinal, D. N., Hanson, D. & Wakeham, J. (1996). Investigation of authorship in facilitated communication. Mental Retardation, 34, 231-242.

"We examined whether facilitated communication users, under controlled conditions, could transmit rudimentary information to a na•ve facilitator. Forty-three students across 10 classrooms were shown a single randomly selected word with their facilitator out of the room. The facilitator then entered the room and asked the student to type the word, which was recorded exactly as typed and later evaluated; approximately 3,800 attempts were conducted over a 6-week period" (231).

"There were two main findings of the study. First, under controlled conditions, some facilitated communication users can pass information to a facilitator when that facilitator is not aware of the information, and second, the measurement of facilitated communication under test conditions may be significantly benefited by extensive practice of the test protocol. This latter result could partially account for the inability of several past studies to verify facilitated communication-user originated input" (238).

Cabay, M. (1994). Brief report: A controlled evaluation of facilitated communication using open-ended and fill-in questions. Journal of Autism and Developmental Disorders, 24, 517-527.

This study involved "four students enrolled in the day school program" (p. 519), ranging in their age from 9 years to 17 years, with "diagnosis of autism or autistic-like traits" (p. 519). They used FC at school "for 3 months or more" (p. 519). Two facilitators participated in the study - one who "had provided occupational therapy for 2 years to the subjects she facilitated with" (p. 519) and another who "had worked daily in the classroom for 6 months with the subjects she facilitated with" (p. 519).

Ten cards "with fill-in or short-answer questions" (p. 520) and ten blank cards were randomly presented to the subjects in two conditions: one "where the facilitator was aware of which card was presented" and another "where the facilitator was unaware of which card was presented" (p. 520).

This study did not support the validity of FC as, "[w]hile 95% of the responses were correct when the facilitator knew which item was presented, only 19% of the responses were correct when the facilitator was unaware of which item was presented.... Most of the incorrect responses (62%) when facilitators were unaware of what was presented resembled correct answers to possible items. Since the facilitators knew the item pool, this suggests they could have been guessing what the items were and thus influencing the answers accordingly" (p. 523).

Emerson, A., Grayson, A., & Griffiths, A. (2001). Can't or won't? Evidence relating to authorship in facilitated communication. International Journal of Language & Communication Disorders, 36 (Supp), 98-103.

"Data for 14 of the participants who have been introduced to FC is included in this paper...The summarized data relate to the issue of 'authorship', i.e. the question of which of the communication partners (facilitator or user) is really responsible for the emergent text. The data come from two main sources- controlled tests (in the style of published experimental studies) and transcripts or diary records of routinely occurring FC sessions" (99).

"Evidence from this project shows similar findings to many of the published studies that conclude, having undertaken controlled tests, that FC is not a valid strategy to use. However, evidence from the same project also suggests that the overall picture with regard to FC may be more complex than this. The same participants who do not provide authorship evidence in controlled trials provide data which indicate that they are authoring their communications when given the opportunity to communicate about things of their own choosing" (100).

Montee, B., Miltenberger, R., & Wittrock, D. (1995). An experimental analysis of facilitated communication. Journal of Applied Behaviour Analysis, 28, 189-200.

This study "evaluated the authorship of messages produced through facilitated communication by 7 adults with moderate or severe mental retardation and their facilitators. The clients had been reported to be communicating fluently through facilitated communication" (p. 189) and they "had been using facilitated communication for 6 to 18 months" (p. 191). The study utilized two evaluation formats, naming pictures and describing activities that the client engaged with the research assistant in a separate room for approximately 5 minutes. In both formats, the following three conditions were conducted: "(a) the facilitator and client had access to the same information [(Known condition)], (b) the facilitator did not have access to the picture or activity [(Unknown condition)], and (c) the facilitator was given false information about the picture or activity [(False condition)]" (p. 189).

For the naming pictures format, "the mean percentage of correct responses in the known condition was 75%, and in the unknown and false conditions the mean percentage was 0% and 1.8%, respectively. In 66% of the trials for the false condition, the subjects typed the picture seen by the facilitator" (p. 195). For the describing activities format, "the mean percentage of correct responses in the known condition was 87%, and in the unknown and false conditions the mean percentage was 0%. In 80% of the false condition trials, the client typed the activity that was correct for the facilitator" (pp. 195-196). Overall, "[t]he results showed that the clients typed the correct answer only when the facilitator had access to the same information, never typed the correct answer when the facilitator had no information or false information, and typed the picture or activity presented to the facilitator when it was different from the one experienced by the client" (p. 189).

Sheehan, C. & Matuozzi, R. (1996). Investigation of the validity of facilitated communication through the disclosure of unknown information. Mental Retardation, 34, 94-107.

"Three individuals (8, 10, and 24 years old with diagnoses of autism and mental retardation) participated in a message-passing format to determine whether they could disclose information previously unknown to their facilitators. Results showed valid facilitated communication from each participant" (94).

"The data from the current study lead us to caution that a phenomena as complex as facilitated communication eludes a cursory exploration. Each participant was able to disclose information accurately and deftly at times and was wholly inadequate in his or her attempts at other times...The developing picture of an individual's validity profile replete with the patterns of required support, inconsistency, language impairment, and strides towards independence may well be the only reasonable evaluation of a validity confidence level" (104).

Vazquez, C. (1994). Brief Report: A multitask controlled evaluation of facilitated communication. Journal of Autism and Developmental Disorders, 24 (3), 369-379.

"The purpose of this study was to test the validity of facilitated communication with autistic subjects, while controlling for cuing or experimenter bias effects. Three different tasks requiring expressive language were used: picture identification; a video task in which subjects are asked to describe a short video to the facilitator; and object identification. Both autistic children...were among the school's most accomplished users of facilitated communication, each having used the technique for at least a year. Ben (12 years 10 months), virtually mute, had expressive language skills limited to natural gestures and simple signing; with facilitation, however, he was completing seventh-grade educational materials...Eva (10 years 10 months) had only echolalic speech and severe language deficit without facilitation...was completing fifth-grade materials..."

In the picture identification task...correct answers were typed only when the facilitator knew the answer...In the video sessions...Ben did well only on his second [of 5] video, canoeing. His answers were generally context-appropriate, and the facilitator was able to figure out the content of the video based on his responses...Ben and Eva typed nonsense and apparently meaningful phrases that were irrelevant [to the other videos]. Eva alone was tested in the [object identification] task. She got 9 out of 10 nonblind items correct and 9 out of 10 blind items correct..."

Can autistic subjects really communicate with facilitation...the results are mixed. Using a variety of tasks, this study provides evidence for genuine communication from these highly selected subjects, as well as strong evidence for direct cuing between subject and facilitator. Erratic in their performance, each subject was able to report information unknown to the facilitator in one out of four controlled sessions..."

Weiss, M.J.S., Wagner, S.H., & Bauman, M.L. (1996). A validated case study of facilitated communication. Mental Retardation, 34 (4), 220-230.

The case of a 13-year-old boy with autism, severe mental retardation, and a seizure disorder who was able to demonstrate valid facilitated communication was described. In three independent trials, short stories were presented to him, followed by validation test procedures with an uninformed facilitator providing physical support to the subject's arm. In trials 1 and 3, several specific answers were provided that clearly indicated that the young man, not the uniformed facilitator, was the source of the information. Moreover, some responses seemed to imply that the subject was employing simple inferential and abstract reasoning. The case study adds to the small, but growing number of demonstrations that facilitated communication can sometimes be a valid method of communication for at least some individuals with developmental disabilities.

Dr. Michael J. Weiss and Dr. Jan Nisbet contributed to this report.

Dr. Weiss is a developmental psychologist at Giant Steps School in Connecticut, a private school for children diagnosed with autism and other developmental disabilities, and also is an adjunct professor in psychology at Fairfield University. He has been a faculty member at the Schools of Medicine at McGill and Harvard Universities and a staff psychologist at the Children's Hospitals in Montreal and Boston. Weiss has worked in private practice and has published numerous articles, chapters, and abstracts related to infancy, children and families, and developmental disabilities.

Dr. Nisbet is director of the Institute on Disability and a tenured associate professor in the Department of Education at the University of New Hampshire. She has conducted research and writing for the past 20 years on topics related to school restructuring and reform, transition from school to adult life, supported employment, self-determination, inclusive adult lives and aging. Institute on Disability Web site external link

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