Updated by:
David Celiberti, PhD, BCBA-D, Kathryn Daly, MA, BCBA, and Jamaun Willis, MEd, BCBA
Association for Science in Autism Treatment

Autism Treatments SummaryDescription: Facilitated Communication (FC) is an intervention in which the service provider, a “facilitator,” holds the participant’s hands, wrists, or arms to help him or her spell messages on a keyboard or a board with printed letters. Important features of FC include physical support and stabilization, acceptance, and emotional encouragement to initiate communicative interactions. It is stated by FC experts that a “facilitator” should never lead the learner to type. The goal of the intervention should be independent communication with the use of the keyboard. FC differs from other communication interventions that involve carefully prescribed and explicitly stated prompting that is systematically faded because it involves ongoing assistance from a facilitator – their assistance is not faded. Other interventions that closely resemble FC have emerged, such as Supported Typing, Saved By Typing, Spelling To Communicate, and Typing To Communicate (Holehan & Zane, 2020). This can be confusing for members of the autism community who consider these other interventions in the absence of the decades of concerns levied against FC, as will be discussed below.

FC also resembles Rapid Prompting Method (RPM) which has its own treatment summary (Daly & Celiberti, 2021). RPM providers similarly often utilize a letter board and eventually handwriting paired with prompts (auditory, visual, and tactile) to encourage students to respond to questions and learning opportunities (Lang et al. 2014). Other similarities to RPM involve the proposition that the learner possesses some “latent abilities,” which the intervention will demonstrate (e.g., Tostanoski, et al., 2014). For a more detailed comparison of FC and RPM, please read the 2018 position statement of the American Speech-Language-Hearing Association.

Some concerns regarding FC have been identified. For example, it is important to note that written products produced by individuals with autism who are facilitated often include vocabulary, written expression, and grammatical structures that are difficult to reconcile with the individual’s existing observable academic or adaptive skills (e.g., Jacobson et al. 1995). Essays have been put forth on social media that are exceptionally well written, devoid of spelling errors, free from grammatical mistakes, and include special formatting and characters. These written products were allegedly independently produced by the individual with ASD despite the observation that the use of italics, quotation marks, and other special keys are not shown on the original letter boards.

Research Summary:

Facilitated Communication

Credit: Artwork by Marina Azimova, EdM, MSW, BCBA

Research evidence, replicated across several hundred children with autism spectrum disorders, shows that the facilitators – rather than the individuals with ASD – control the communication, and that FC does not improve language skills (Mostert, 2001). Other studies have evaluated the accuracy of FC when the facilitator is “blind” to the correct answer (Montee et al., 1995). In one carefully designed study, a pattern was observed in which facilitated answers were correct when the facilitator knew the answer to the question. When the facilitator did not know the answer or the keyboard was not in view, accuracy was notably compromised (Saloviita, et al., 2014). Other recent studies have tested whether communicators can recognize written words that they frequently use to communicate with the help of their facilitators (e.g., Roane et al. 2019). Roane and colleagues (2019) reviewed over 100 pages of facilitated text to identify commonly used words and found no evidence that the participant could correctly receptively identify those words.

In a review of recent research published between 2014 and 2018, Helmsley and colleagues reported that there continued to be no studies demonstrating authorship by individuals with communication disabilities whose messages were generated using FC (e.g., Helmsley et al., 2018). Further, FC has been shown to be harmful in certain instances in which it has led to false allegations of abuse against family members of users (Celiberti, 2010; Green, 1995; Green & Shane, 1994; Lilienfeld, 2007; Lilienfeld, et al 2014). Based on these and other studies conducted on the effectiveness of FC (e.g., Kerrin et al., 1998, Kezuka, 1997), it is not considered to have scientific evidence and is not recommended as a communication intervention for individuals with autism spectrum disorders.

Recommendations:

Facilitated Communication is not an evidence-based intervention for individuals with autism spectrum disorders and should be avoided. In many other treatment summaries, we offer suggestions for future research that may enhance the scientific basis for a particular treatment. As discussed above and as reported in the systematic reviews cited below, FC proponents have had nearly 4 decades to produce data to support their overstated and inflated claims or counter the research that casts significant doubt on the validity of FC and have failed to do so. It is their ethical responsibility to demonstrate the validity of their work. It is also important to note that numerous professional organizations including, but not limited to, the American Academy of Pediatrics (AAP) and the American Psychological Association (APA), have issued position statements advising against the use of FC in treating autism (please see the extensive list below with links to the original statements). In fact, there is no other intervention in the treatment of autism that has amassed so many warnings.

Readers may be interested to know that the Association for Science in Autism Treatment has sponsored this special issue from Evidence-based Communication Assessment and Intervention which provides a comprehensive overview of the evidence (or lack thereof) for FC from different perspectives—scientific, ethical, and conceptual and informs service providers, family members, and the public about the risks and dangers of these methods. The collection of articles included in this special issue also highlights the importance of promoting evidence-based practices that respect the dignity and autonomy of individuals with communication impairments, as well as their right to interventions that bolster their communication skills based on the very best that science has to offer.

Interventions that are recommended for improving the communication skills of individuals with autism include Verbal Behavior, Incidental Teaching, Picture Exchange Communication System (PECS), Discrete Trial Instruction, Pivotal Response Training, Natural Language Paradigm, and many other behavior analytic teaching procedures.

Although the flagrant promises of FC are to allow people to communicate who otherwise cannot, the evidence against its use is firm. Beyond studies showing that FC cannot be relied upon to validly support the independent expression of its users, this so-called intervention insists that the user is reliant on the support of the facilitator. The aim of evidence-based treatments is to bolster independent communication. Readers beware and warn others against the use of FC. Position statements by a substantial list of organizations are shared below.

Position statements by professional organizations against the use of FC:

Selected References:

Systematic reviews of scientific studies:

Hemsley, B., Bryant, L., Schlosser, R.W., Shane, H.C., Lang, R., Paul, D, Banajee, M., & Ireland, M. (2018). Systematic review of facilitated communication 2014-2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism and Developmental Language Impairments, 3, 1-8. https://doi.org/10.1177/2396941518821570

Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2016). Facilitated Communication: The ultimate fad treatment. In R. M. Foxx & J. A. Mulick (Eds.) Controversial therapies for autism and intellectual disabilities: Fads, fashion, and science in professional practice. (pp. 283-302). New York, NY: Routledge.

Mostert, M. P. (2001). Facilitated Communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders, 31, 287-313. https://doi.org/10.1023/A:1010795219886

Schlosser, R.W., Balandin, S., Hemsley, B., Iacono, T., Probst, P., Von Tetzchner, S. (2014). Facilitated communication and authorship: A systematic review. Augmentative and Alternative Communication. 30(4), 359-368. https://www.researchgate.net/publication/268227789

Selected scientific studies:

Kerrin, R. G., Murdock, J. Y., Sharpton, W. R., & Jones, N. (1998). Who’s doing the pointing? Investigating facilitated communication in a classroom setting with students with autism. Focus on Autism and Other Developmental Disabilities, 13, 73-79. https://doi.org/10.1177/108835769801300

Kezuka, E. (1997). The role of touch in Facilitated Communication. Journal of Autism and Developmental Disorders, 27, 571-593. https://doi.org/10.1023/A:1025882127478

Montee, B. B., Miltenberger, R. G., & Wittrock, D. (1995). An experimental analysis of Facilitated Communication. Journal of Applied Behavior Analysis, 28(2), 189-200. https://doi.org/10.1901/jaba.1995.28-189

Roane, H. S., Kadey, H. J., & Sullivan, W. E. (2019). Evaluation of word recognition following typing produced through Facilitated Communication. Journal of Applied Behavior Analysis, 52(4), 1107-1112. https://doi.org/10.1002/jaba.587

Saloviita, T., Leppänen, M., & Ojalammi, U. (2014). Authorship in Facilitated Communication: An analysis of 11 cases. Augmentative and Alternative Communication, 30(3), 213-225. https://doi.org/10.3109/07434618.2014.927529

Timo, S. (2019). Does linguistic analysis confirm the validity of Facilitated Communication? Focus on Autism and Other Developmental Disabilities, 33(2), 91-99. https://doi.org/10.1177/1088357616646075

Other articles cited above:

Celiberti, D. (2010). Facilitate this: Part I of a two-part interview with Dr. James Todd. Science in Autism Treatment, 7(2), 1-8.

Daly, K., & Celiberti, D. (2021). A treatment summary of Rapid Prompting Method. Science in Autism Treatment, 18(1).

Green, G. (1995). An ecobehavioral interpretation of the Facilitated Communication phenomenon. Psychology in Mental Retardation and Developmental Disabilities. 21(2), 1-8.

Green, G., & Shane, H. C. (1994). Science, reason, and Facilitated Communication. The Journal of the Association for Persons with Severe Handicaps, 19, 151-172. https://doi.org/10.1177/154079699401900302

Holehan, K. M., & Zane, T. (2020). Facilitated Communication reincarnated: Is there science behind that? Science in Autism Treatment, 17(5).

Jacobson, J. W., Mulick, J, A., & Schwartz, A. A. (1995). A history of Facilitated Communication: Science, pseudoscience, and antiscience (Science working group on Facilitated Communication). American Psychologist, 50(9), 750-765. https://doi.org/10.1037/0003-066X.50.9.750

Lang, R., Tostanoski, A. H., Travers, J., & Todd, J. (2014). The only study investigating the rapid prompting method has serious methodological flaws, but data suggest the most likely outcome is prompt dependency. Evidence-based Communication Assessment and Intervention, 8(1), 40-48.

Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2(1), 53–70. https://doi.org/10.1111/j.1745-6916.2007.00029.x

Lilienfeld, S. O., Marshall, J., Todd, J. T., & Shane, H. C. (2014). The persistence of fad interventions in the face of negative scientific evidence: Facilitated Communication for autism as a case example. Evidence-Based Communication Assessment and Intervention, 8, 62-101. https://doi.org/10.1080/17489539.2014.976332

O’Connell-Sussman, E., & Weiss, M. J. (2021). A non-exhaustive list of current position statements related to autism treatment. Science in Autism Treatment, 18(11).

Tostanoski, A., Lang, R., Raulston, T., Carnett, A., & Davis, T. (2014). Voices from the past: Comparing the Rapid Prompting Method and Facilitated Communication. Developmental Neurorehabilitation, 17(4), 219-223. https://doi.org/10.3109/17518423.2012.749952

Citation for this article:

Celiberti, D., Willis, J., & Daly, K. (2024). A treatment summary of Facilitated Communication. Science in Autism Treatment, 21(7).

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