David Celiberti, PhD, BCBA-D and Kathryn Daly, MA, BCBA, LBA
Association for Science in Autism Treatment
Description: Facilitated Communication (FC) is a purported 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 for the learner’s arm, wrist, or hand, acceptance, and emotional encouragement to initiate communicative interactions. It is stated by FC experts that a “facilitator” should never lead the learner to type and the ultimate goal for the intervention should be independent communication with the use of the keyboard. Because it involves ongoing assistance from a facilitator, FC differs from teaching efforts that involve initially providing prompts and cues to teach an individual to independently write, type, or use a computerized device for communication purposes. On the other hand, it has been reported that other interventions that closely resemble FC have emerged such as Supported Typing, Saved By Typing, Spelling To Communicate, Typing To Communicate (Holehan & Zane, 2020). Written products produced by facilitated individuals with autism often includes vocabulary and grammatical structures that are difficult to reconcile with other academic or adaptive indicators (e.g., Jacobson, Mulick, & Schwartz, 1995).
Research Summary: Research evidence, replicated across several hundred children with autism spectrum disorders, shows that the facilitators rather than the individuals with autism spectrum disorders control the communication and that FC does not improve language skills (Mostert, 2001). Other studies have evaluated the accuracy of Facilitated Communication when the facilitator is “blind” to the correct answer (Montee, Miltenberger, & Wittrock, 1995). Recent studies have tested whether communicators can recognize written words that they frequently communicate with the help of their facilitator (Roane, Kadey, & Sullivan, 2019). These researchers found that despite having an extensive receptive language repertoire, the communicators could not recognize the words that they commonly used with the facilitator. Based on these and other studies conducted on the effectiveness of FC, it is not considered to have scientific evidence and is not an appropriate communication intervention for individuals with autism spectrum disorders. 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). Therefore, FC is an inappropriate 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. Numerous professional organizations including, but not limited to, the American Academy of Pediatrics and the American Psychological Association, have issued position statements advising against its use in treating autism (please see extensive list below). Interventions which are recommended for treating autism, specifically targeting communication skills, include Verbal Behavior, Incidental Teaching, Pivotal Response Treatment/Natural Language Paradigm, and many other behavior analytic teaching procedures.
Systematic reviews of scientific studies:
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.
Selected scientific studies:
Montee, B. B., Miltenberger, R. G., & Wittrock, D. (1995). An experimental analysis of Facilitated Communication. Journal of Applied Behavior Analysis, 28(2), 189-200.
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.
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.
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.
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.
Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2(1), 53–70.
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
Position statements by professional organizations:
American Academy of Child and Adolescent Psychiatry. (1993, October). Policy statement of Facilitated Communication. AACAP Newsletter, February 1994. Reviewed June 2008.
American Academy of Pediatrics. (1998). Auditory integration training and Facilitated Communication for autism. Pediatrics, 102, 431-433. This was reaffirmed in 2009.
American Association on Mental Retardation. (1994). AAMR Board approves policy on Facilitated Communication. AAMR News & Notes, 7(1). Now called the American Association on Intellectual and Developmental Disabilities.
American Association of Intellectual and Developmental Disabilities (2019) Facilitated Communication and Rapid Prompting Method: Position Statement of the AAIDD Board of Directors.
American Psychological Association. (1994). Resolution on Facilitated Communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California.
Association for Behavior Analysis. (1995). Statement on Facilitated Communication. ABA Newsletter, 18,(2).
International Society for Augmentative and Alternative Communication (2014). ISAAC Position Statement on Facilitated Communication, Augmentative and Alternative Communication, 30:4, 357-358, https://doi.org/10.3109/07434618.2014.971492
Speech-Language & Audiology Canada (2018). Use of Facilitated Communication and Rapid Prompting Method.
Victorian Advocacy League for Individuals with Disability. Position Statement on the Use of Facilitated Communication.
Related ASAT Articles:
Media Watch Letters:
Citation for this article:
Celiberti, D., & Daly, K. (2020). A treatment summary of Facilitated Communication. Science in Autism Treatment, 17(8).