Breanna Roberts, MA, BCBA, Elizabeth Hardesty, MA, BCBA, and Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of Kansas

Is there science behind thatIt is estimated that 25-30% of children with autism remain minimally verbal, typically producing only a limited number of words by the age of five (Anderson, et al., 2007; Billstedt et al., 2007; Rose et al., 2016). This finding highlights an urgent need to identify interventions or alternative communication methods that enable autistic individuals to interact and communicate effectively across various settings. Research has identified several evidence-based practices for improving self-directed communication outcomes for individuals with intellectual and developmental disabilities. These practices include incidental teaching (Hart & Risley, 1968, 1975; McGee et al., 1983), milieu teaching (Kaiser & Roberts, 2013), pivotal response training (Koegel & Koegel, 2006), functional communication training (Gerow et al., 2018), and discrete trial teaching (Lerman et al., 2016). These methods teach self-directed communication skills by addressing the function of less desirable behaviors and using naturally occurring motivators, interests, and prompts in the individual’s everyday environment to facilitate learning alternative, appropriate communication strategies. The goal of these strategies is to empower autistic individuals to independently recognize when and how to engage in appropriate communication to advocate for themselves and meet their needs. Additionally, augmentative and alternative communication (AAC) systems—such as the picture exchange communication system (PECS; Frost & Bondy, 2002), manual signs, speech-generating devices (SGDs), and tablet-based AAC applications have shown substantial evidence for increasing both expressive and receptive communication skills (Bowman, 2023; Travers & Pennington, 2022).

Despite the availability of these evidence-based methods, some professionals working with minimally verbal individuals continue to use and teach facilitator-dependent techniques such as Spelling to Communicate (S2C). S2C is similar to other facilitator-dependent techniques, including Facilitated Communication (FC), assisted typing, facilitated communication training, supported typing, and the Rapid Prompting Method (RPM). These variants of facilitator-dependent methods have little to no empirical evidence to support their use (Jacobson et al., 1995; Saloviita et al., 2014; Schlosser et al., 2014; Shane, 1994). This raises the question of how S2C differs from these unproven methods and whether current evidence supports S2C’s use in teaching communication.

What is Spelling to Communicate?

S2C is advertised as an alternative method of communication for nonspeaking individuals, and they are taught motor skills such as pointing to letters on a board to spell out words and phrases (International Association for Spelling as Communication, n.d.). This process is facilitated by a Communication Regulation Partner (CRP), who uses structured lessons tailored to the learner’s interests and various prompting techniques (e.g., physical, gestural, or verbal prompts). Proponents of S2C assert that the goal is to “achieve synchrony between cognition and motor” as integrating those two things leads to “improved physical and emotional regulation” (International Association for Spelling as Communication, n.d.). Furthermore, they claim that S2C can lead to “improved access, quality of life, and opportunities to be contributing members of society” (International Association for Spelling as Communication, n.d.).

How is Spelling to Communicate Implemented with Individuals with Autism?

The S2C method starts by presuming that nonspeaking individuals are competent with receptive and expressive language without direct teaching, have the capacity to think, learn, and understand, and can engage in intentional motor movements (International Association for Spelling as Communication, n.d.). S2C involves a nonspeaking individual working closely with an S2C practitioner and CRP to develop the nonspeaking individual’s motor skills to point to letters on a board and spell out words or phrases. The S2C Practitioner is trained to teach the entire process of S2C and works with multiple clients and CRPs. The CRP provides one-on-one communication support and can be anyone who received speller-specific training from the S2C Practitioner to assist the individual at their current skill level. In contrast to self-directed communication, support from a CRP is always needed for the speller to communicate. It often includes physical guidance at the hand or wrist, along with initiation, continuation, eye gaze, or directional prompts. These prompts are used to help the speller learn the motor movements required to spell and to compete with internal and external distractions (e.g., presence of other people, noise in the background, etc.), so the speller can remain focused on the S2C skills. Additionally, proponents assert that these prompts are used as feedback, helping the speller complete the task correctly to increase future independence.

Skills in S2C are practiced within structured lessons to facilitate “meaningful and intelligent conversations” (International Association for Spelling as Communication, n.d.). Lessons are chosen based on the speller’s interests (e.g., marathon running, gratitude, dogs) and include multiple paragraphs with relevant information. The lesson is read to the speller, and questions are interspersed throughout the lesson, providing opportunities to practice spelling words and answering questions related to the text. For example, a lesson on Christmas traditions might include spelling the word “traditions” and answering questions like, “What holiday tradition is being discussed?” or “What is the name of another holiday movie?” As learners respond more accurately, spellers progress from single-letter responses to simple words, phrases, and full sentences.

Although the S2C methods may share some similarities with evidence-based practices, such as incorporating the interests of the nonspeaking individual to increase motivation to engage in communicative responses, its structure focuses on a question-and-answer format rather than teaching functional communication skills. In contrast, the evidence-based practices mentioned above prioritize teaching nonspeaking individuals how to effectively communicate their needs, wants, and navigate social interactions. Bondy et al. (2020) identified nine critical communication skills that support independent communication, including requesting desired items or activities, requesting assistance, requesting a break, rejecting offers, accepting offers, responding to “wait” or “no,” following directions, following a schedule, and transitions. Unlike S2C, which emphasizes spelling responses to scripted questions, these nine skills aim to help individuals develop independent and spontaneous communication, allowing them to be as independent as possible.

Spelling to Communicate: Is There Science Behind That?

Before reviewing the science (or lack of it) supporting S2C, a fundamental assumption of S2C must be discussed. S2C relies on the assumption that the individual lacking communication skills is presumed to be competent with language. However, critics of S2C argue that “users appear to generate sophisticated written language about abstract concepts or detailed academic content despite significant cognitive impairments and in the absence of requisite formal literacy instruction” (Travers & Pennington, 2022, p. 384). Similar claims have been raised regarding a debunked strategy, Facilitated Communication (Shane, 1994). Thus, the fundamental assumption of S2C and FC appears to be the same and faulty.

S2C’s website highlights a collection of research that is intended to support its methods. However, of the 13 studies on their website, only seven have been published (Alabood et al, 2022; Jaswal et al., 2024; Jaswal et al., 2020a; Jaswal et al., 2020b; Krishnamurthy et al., 2022; Lampi & Jaswal, 2022; Sargent & Jaswal, 2022). Before we discuss some of these studies more explicitly, it is important to note that listing 13 studies without empirical evidence may mislead parents and educators into believing S2C has a more substantial research base than it does. Of the 7 that are published, two are non-empirical articles (Alabood et al., 2022; Krishnamurthy et al., 2022) that propose using different mixed-reality and augmented reality to increase the ability of minimally verbal persons to communicate via pointing to spell. Three publications evaluated indirect outcomes related to S2C, such as social connection (Jaswal et al., 2020a; Lampi & Jaswal, 2022; Sargent & Jaswal, 2022) but did not evaluate S2C methods at all. Only two articles directly assessed the use of S2C procedures (Jaswal et al., 2024 & Jaswal et al., 2020b). While these studies represent the current and most relevant research for S2C, raising additional questions about the evidence for S2C, given the little empirical data to support S2C.

Additionally, Jaswal et al. (2020b) evaluated S2C using head-mounted eye-tracking software to investigate the “communicative agency” of nonspeaking autistic individuals. Participants had reported using letterboards for at least 2.25 years and had varying vocal-verbal abilities ranging from a few word approximations to a limited number of utterances or scripted phrases. Participants attended one 30-minute session with an S2C assistant. During the session, the assistant sat to the participant’s right, read each lesson plan section aloud, and asked 1-6 questions of varying types (e.g., spelling, comprehension, semi-open-ended, and open-ended). Participants answered by pointing at letters on the letterboard while the Yarbus software tracked the participant’s gaze. Results showed high word and letter accuracy levels and that participants fixated on correct letters before pointing to them in an average of 71% of opportunities. The authors suggest that these results indicate that participants were not simply looking at and pointing to letters that the assistant cued them to but rather that the participants were actively generating their own text. However, there are several limitations worth mentioning. First, the study did not include a facilitator-free condition to identify the effect of the facilitator on participant responding. This point is incredibly important, given that FC, of which S2C is a variant, was discredited after showing a lack of correspondence when facilitators were blind to the stimuli presented to participants (Bligh & Kupperman, 1993; Cabay, 1994; Eberlin et al., 1993; Hemsley et al., 2018; Herbert et al., 2002; Hudson et al., 1993; Jacobson et al., 1995; Regal et al., 1994; Schlosser et al., 2014; Saloviita et al., 2014; Shane & Kearns, 1994; Simon et al., 1994; Vasquez, 1994; Wheeler et al., 1993). Furthermore, the authors acknowledged the potential of facilitator influence, stating, “This is not to deny that the assistant occasionally influenced the participants” (p. 6). Thus, it is unclear to what extent the facilitator influenced the responding of individuals using letterboards. Third, although the study demonstrated participants’ spelling responses to content-specific questions with a facilitator present, the extent to which this skill generalizes to other essential life skills is unclear. For example, the ability to spell during structured lessons may not necessarily translate to spontaneous communication in real-world situations required for an individual to have their needs and wants met. Thus, the claim that the results demonstrate communicative agency may be overstated.

Jaswal et al. (2024) evaluated whether autistic individuals with limited to no vocal-verbal behavior could spell. However, the study did not use the S2C methodology as the intervention. Despite this, the study is referenced in a list of works supporting S2C, which is misleading. Participants reported using letterboards for at least 2 years. Participants were shown 26 possible targets during the assessment, consisting of a grid with different letters or nonsense symbols displayed on an iPad. Experimenters instructed the participants to tap the pulsing letters or symbols as quickly as possible in the four conditions: sentences, matched symbol sequences, reversed letter sequences, and reversed symbol sequences. Results indicated that participants were faster to tap targets in the sentences condition than in the other conditions. Based on these findings, the authors suggested that many nonspeaking autistic individuals have learned English spelling conventions, categorizing them as having “foundational literacy skills” (p. 2503). However, these conclusions should be interpreted with a high degree of caution. First, the lack of a control group leaves readers wondering whether individuals not exposed to S2C would respond similarly. This prevents the reader from drawing a direct connection between S2C and the ability to spell. Second, although the authors attribute faster responding in the sentence condition to “foundational literacy skills,” another possible explanation could be familiarity. Given the prevalence of letters in learners’ day-to-day environments, it is unclear whether responding was due to literacy skills or simply familiarity with letters compared to the novelty of the symbols or reversed letter sequences. Third, implementing only one session of each condition does not allow for an evaluation of the effects of exposure to the novel symbols or reversed letter sequences. If participants had been given more time with the symbols and reversed letter sequences, their responses might have been just as quick as in the sentence condition. Last, the authors noted that 29 of the 31 participants had received or were still receiving speech therapy during the study. This point raises questions about whether responding can be solely attributed to S2C procedures or the influence of other interventions (see Rey & O’Neill, 2024).

Overall, the studies on the S2C website have not provided empirical proof that S2C was solely responsible for increasing self-directed communication for autistic individuals. Further, reviews conducted on its counterpart (FC) have delineated FC as a fad treatment and outlined the dangers of its use (e.g., Chan & Nankervis, 2014; Hemsley et al., 2018). All of this, taken together with statements refuting the use of FC made by several organizations such as the American Academy of Child and Adolescent Psychiatry (AACAP), American Academy of Pediatrics (AAP), American Speech-Language-Hearing Association (ASHA), National Council on Severe Autism (NCSA), International Society for Augmentative and Alternative Communication (ISAAC), Science-Based Medicine, and Disability Compliance for Higher Education (links to position statements listed below), suggest that S2C should not be used as an intervention to increase communication.

What is the Gist?

Similar to the conclusions drawn four years ago by Holehan and Zane (2020), we do not recommend S2C or similar facilitated communication counterparts (e.g., FC, assisted typing) as an intervention to increase communication skills for minimally verbal individuals. The studies claiming to provide evidence supporting S2C lack rigorous experimental methodology and empirical evidence, emphasizing the absence of proof regarding its efficacy. At best, practitioners of S2C have failed to research their procedures to substantiate their positive effects; at worst, S2C Practitioners risk harming minimally verbal individuals by promoting interventions that may hinder progress.

What Else Should We Consider?

We encourage readers to use a healthy dose of skepticism when interventions that seem too good to be true are presented, with extra emphasis on awareness of the harmful and unintended consequences of non-evidence-based interventions like S2C. First, S2C involves dependence on another person with no outlined procedures in the abovementioned studies to fade out support. Thus, this dependence prevents the opportunity for an individual with autism or other developmental disabilities to engage in independent communication and violates the fundamental human right to an independent communication modality. Second, using non-evidence-based interventions may result in false hope for caregivers and waste resources and valuable time. The time spent preparing, traveling, receiving S2C services, and purchasing the materials could be spent accessing services incorporating evidence-based interventions. Third, facilitator-dependent techniques historically have a high risk of unfounded sexual and physical abuse claims (Boynton, 2012; Chan & Nankervis, 2014; Probst, 2005; Wombles, 2014). This may result in damaged relationships between autistic individuals and their caregivers, between two or more caregivers, and between service providers and those they serve. Additionally, there is always the risk of abused individuals no longer being listened to due to previous unfounded claims. As always, caregivers and service providers will be more effective in teaching skills (including communication) by using the large number of procedures that have empirical evidence from well-designed research studies showing that they work and provide tangible benefits to the consumer.

Position Statements by Professional Organizations (Celiberti et al., 2024)

References

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Reference for this Article

Roberts, B., Hardesty, E., & Zane, T. (2025). Spelling to Communicate: Is there science behind that? Science in Autism Treatment, 23(4).

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