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. DOI: 10.1080/17489539.2014.976332.
Reviewed By Alice Bravo, MEd
With the multitude of marketed interventions for autism spectrum disorder (ASD), identifying which to pursue and which to avoid is a common struggle for families of children with ASD, as well as the providers who serve them. Researchers have subjected many of these interventions to scientific scrutiny. Unfortunately, even after being found to be ineffective by scientific research, some interventions continue to be marketed and implemented. In a significant article published in the journal Evidence-Based Communication Assessment and Intervention, Lilienfeld, Marshall, Todd and Shane (2015) – researchers from Emory University, Eastern Michigan University and Boston Children’s Hospital – discussed reasons why interventions that have been deemed ineffective by scientific research continue to be utilized. In tackling this important and relevant topic, the authors used facilitated communication (FC), a practice targeting expressive communication among nonspeaking individuals, as a case example.
Facilitated communication is a practice involving two people: the non-speaking individual and a “facilitator” – an individual who supports the hand and/or arm of the non-speaking person as he or she uses a keyboard or similar device to type a message. The goal is that this supported use of a keyboard will allow the non-speaking individual to communicate. This approach to expressive communication intervention gained popularity in the early 1990’s, but by the mid- to late-1990’s it had been discredited by research and was thus rejected by the scientific community. This was largely due to the replicated finding that facilitators tended to have control over the actual communication. While facilitators were often convinced that they were simply supporting an individual’s hand, rigorous studies tested this by asking questions to FC users in two conditions; in one, the facilitators did not know the answers to the questions, and in the other, they did. The studies demonstrated that FC only “worked” when the facilitators knew the answers to the questions posed. Additionally, numerous abuse allegations against FC users’ caregivers emerged through communication supported by facilitators, the majority of which were never substantiated. Yet despite all of the evidence against FC and a previous decline in its use, FC use has persisted and even appears to be making a comeback, sometimes under a new name (e.g., “supported typing”).
Lilienfeld et al. (2015) analyzed what could lead to the persistence of “fad” treatments such as FC; a fad treatment being one that has “short-lived enthusiasm” and a “rapid loss of popularity” (Best, 2006). Two typical routes that fad interventions tend to take were described: 1. They are demonstrated as ineffective by scientific studies and subsequently abandoned, or 2. They are validated by research and thus adopted by clinical professionals (Overholser, 2014). In their analysis, Lilienfeld et al. (2015) identified a third route of fad interventions: once deemed unsuccessful by scientific research, the fad treatment “goes underground” and remains utilized within various professional communities, where it acquires enough respectability to be sustained. In this situation, there are too few researchers concerned with the treatment’s credibility and, as a result, the scientific community fails to speak out against its continued use.
Rationale for the Persistence of Fad Treatments
What causes an intervention to take this third route? One reason such treatments seem to attain a strong footing is due to “naïve realism” – the belief that our subjective experiences regarding treatment effectiveness outweighs that of data gathered through controlled studies (Ross & Ward, 1996). Consequently, when an individual hears about or sees what appears to be successful implementation of FC, he or she may believe that this single experience negates the findings of scientific research.
An additional factor is “confirmation bias,” which leads us to pursue evidence that confirms our existing beliefs and to disregard or explain away evidence that does not (Nickerson, 1998). Confirmation bias may lead individuals to focus on the few studies that demonstrate success of FC, while ignoring the considerably larger number of studies demonstrating otherwise. In FC’s case, not only are there more studies disproving its effectiveness, but also the better-controlled studies have reported the least cases of support for FC (Mostert, 2010).
A third element potentially contributing to the persistence of fad treatments is the “familiarity backfire effect.” This is a phenomenon in which an individual believes something to be true and/ or effective simply due to hearing about it multiple times – that is, being “familiar” with the treatment. For this reason, Lilienfeld et al. (2015) argued that one of the important aspects of combatting a scientifically debunked and yet persisting fad treatment is to provide a replacement treatment. In the case of FC, this involves the promotion of scientifically supported augmentative and alternative communication (AAC) methods and applied behavior analysis (ABA). Both of these treatment methods are supported by scientific research and can be used to target expressive communication, as FC was originally meant to do.
The widespread promotion of evidence-based interventions for ASD and related disabilities can provide parents with a genuine hope for supporting their loved ones. Lilienfeld et al. (2015) encourage researchers in the fields of communication disorders, psychology and education to become more involved in speaking out against fad interventions that have been discredited, and simultaneously to actively promote scientifically supported interventions. In addition to conducting research, scientists play an important role in disseminating their findings in order to ensure that unsupported interventions are permanently put aside in favor of ones that are backed by science.
Best, J. (2006). Flavor of the month: Why smart people fall for fads. Berkeley, CA: University of California Press.
Mostert, M. P. (2010). Facilitated communication and its legitimacy—twenty-first century developments. Exceptionality, 18, 31-41.
Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2, 175-220.
Overholser, J. C. (2014). Chasing the latest fad: Confronting recent and historical innovations in mental illness. Journal of Contemporary Psychotherapy, 44, 53–61.
Ross, L., & Ward, A. (1996). Naive realism: Implications for social conflict and misunderstanding. In T. Brown, E. Reed, & E. Turiel (Eds.), Values and knowledge (pp. 547–135). Hillsdale, NJ: Erlbaum.
Citation for this article:
Bravo, A. (2015). The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example. Science in Autism Treatment, 12(2), 34-36.