Boynton, J. (2024). Questions to ask facilitators and yourself while observing FC/S2C/RPM sessions. Facilitatedcommunication.org https://www.facilitatedcommunication.org/blog/questions-to-ask-facilitators-and-yourself-while-observing-fc-s2c-rpm-sessions

Reviewed by Smrithi Thyagarajan (Extern) and David Celiberti, PhD, BABA-D
Association for Science in Autism Treatment

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

The Association for Science in Autism Treatment (ASAT) firmly believes that consumers are well within their rights to question providers and to receive accurate, complete, clear, and objective responses to guide decision making. The article reviewed herein exemplifies this right and provides a solid path for family members, other consumers, and providers to ask questions, particularly as they relate to facilitator-dependent methods. In this article, Janyce Boynton (2024) focuses on the evaluation of different facilitator-dependent methods such as Facilitated Communication (FC), Spelling to Communicate (S2C), and Rapid Prompting Method (RPM). Whereas other articles have addressed the lack of science demonstrating the effectiveness and validity of these communication methods after multiple decades of use (e.g., Celiberti, Daly, & Willis, 2024; Daly & Celiberti, 2021, Hemsley et al., 2018; Holehan & Zane, 2020; Lang et al., 2014; Saloviita et al., 2014), Boynton astutely highlights the necessity for stakeholders to be observant regarding the potential for facilitator influence, which can unintentionally guide the responses of the individuals being assisted.

The article begins by emphasizing the importance of understanding FC, S2C, and RPM methodology and stresses the need for independence of the communicator from the facilitator. Therefore, it is critical to observe whether the individual is initiating communication independently or if the facilitator is directing, or otherwise influencing, their responses. Observers are strongly encouraged to look for physical or visual cues or prompts that could suggest facilitator influence.

The author also encourages visual analysis to detect facilitator cueing when facilitators don’t wish to partake in testing. Such analysis of videotapes could involve slowing down the video to assess subtleties. This is crucial because the validity of the communication depends on whether the responses are genuinely generated by the individual. Given the historical concerns surrounding FC (e.g. Lilienfeld et al, 2014), this article addresses the unethical implications of using facilitated communication and advocates for the importance of respecting the actions of the individuals who are being facilitated. The author states, “Reliably controlled ‘blind’ tests or message-passing tests reduce the likelihood of false positives.” By setting up situations in which facilitators are unaware of what the individual is asked to communicate, the possibility of wrongful cueing is greatly minimized.

Boynton provides a list of over a dozen questions that observers should ask to critically analyze the session and allows the observer or stakeholder to detect facilitator cueing. These suggestions offered in the article help observers determine if the communication truly reflects the individual’s thoughts and not the facilitator’s sway over responses. The questions are designed to evaluate the technique of the facilitator and judge the overall environment of the session. They aim to determine the level of independence of the individual versus the facilitator’s influence, evaluate the amount of engagement, the responsiveness, the nature of deliberate letter board selections, and analyze verbal or non-verbal communication. These questions can promote objective evaluation and ethical practice in facilitated communication. This is to protect against unprincipled facilitator influence or misrepresentation/ misunderstanding of the individual’s communication abilities.

We have used Boynton’s thought provoking and preliminary list of questions as a springboard which has inspired us to offer a more extensive list. We have further categorized these questions thematically.

Questions to ask regarding communicator’s background:

    • Aside from the current use of the letter board, can the communicator demonstrate seemingly prerequisite skills such as receptive identification of letters, letter matching, sound symbol correspondence, listening comprehension, and/or spelling?
    • When were these skills initially developed? Using what teaching methods? By whom and for how long? Are they reflected in any formal assessments or in school-generated progress reports?
    • For communicators who are taking courses requiring reading, how has reading been taught? Can basic reading comprehension be reliably demonstrated (e.g., an individual reads instructions such as “tap table” and then performs the corresponding action).
    • What does reading look like? Is the communicator able to hold an open book? Can they turn the book pages themselves? If the textual content is presented online, are they able to scroll?
    • What is the quality of the attention when presented with text (either in print or online)?
    • Where else in daily life does the communicator require physical support (e.g., drinking from a cup, using a spoon, brushing teeth, wiping, zippering, matching tasks)? What is the level of wrist stabilization needed for the communicator to perform these activities?
    • What has been the history of Augmentative and Alternative Communication (AAC) interventions? What has been tried? What have been the communicator’s prior communication modalities? How successful were they? How generalizable across settings are these skills?
    • Aside from pointing to letters, can the communicator point to preferred items? Are these instances of pointing independent?
    • What are the communicator’s spoken language abilities, if any?

Questions to ask regarding communicator’s use of the letter board and facilitator behavior:

    • What is the least intrusive prompt level needed for letter selection to occur? How has the facilitator been fading prompts? Is this fading documented?
    • Who are the people who can facilitate the communication? How have they been trained? Any differences in output across the different facilitators?
    • How are selected letters recorded in real time? Does the facilitator write with one hand and facilitate with the other? Are other electronic recording systems used to document communications made?
    • Have you ever looked away from the board (or made a conscious effort to close your eyes)? What happened as reported by a third party? Are you willing to try that?
    • How do you tailor your approach with different communicators? How do you respond in situations when the communicator is frustrated or refuses to participate?
    • What strategies do you use to maximize engagement?

Questions to ask regarding final products (such as a complete essay):

    • How long did it take to produce this essay? Did the communicator ever lose their train of thought?
    • It is uncommon for any author to write an essay from start to finish in a single draft without the benefit of editing spelling errors and arranging ideas through cutting and pasting. Can you share details about how this essay was produced? How many times was it edited to get it to its current state?
    • While most letter boards do not include both upper- and lower-case letters, who made decisions about when upper casing and lower casing would be used? Similar questions can be asked about punctuation missing from the board such as semicolons, colons, and quotation marks.

Neither the list of questions above (again inspired by Boynton) nor the list shared in her paper are meant to be exhaustive and selection would vary based on the circumstances and context. Regardless of what is asked, facilitators should be transparent regarding their methods and should allow scrutiny to guarantee that communication is authentic, and that the facilitator is not “accidentally” cueing the individual from making their decision/selection. Again, the importance of transparency should be embraced by all providers regardless of methodology, years of experience, etc.

The author also hopes that the provided questions will be used while observing facilitation sessions and/or asked of the facilitator before or after these sessions, and that these will help in assessing whether the facilitator is interfering with letter board selection. The article urges both facilitators and observers to prioritize the autonomy and genuine expression of the individuals being facilitated to best help the individual. By validating the communication’s authenticity, the communicator’s integrity and agency is protected and ethical practice is promoted.

References:

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

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

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 & Developmental Language Impairments. https://doi.org/10.1177/2396941518821570

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

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., Marshall, J., Todd, J., & Shane, H. (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(2) 62-101. https://doi.org/10.1080/17489539.2014.976332

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

Schlosser, R. W., & Prabhu, A. (2024). Interrogating neurotypical bias in Facilitated Communication, Rapid Prompting Method, and Spelling 2 Communicate through a humanistic lens. Current Developmental Disorders Reports, 11(1), 41-51. https://doi.org/10.1007/s40474-024-00296-w

Citation for this article:

Thyagarajan, S., & Celiberti, D. (2024). A review of Questions to ask facilitators and yourself while observing FC/S2C/RPM sessions. Science in Autism Treatment, 21(8).

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