Schlosser, R. W., Hemsley, B., Shane, H., Todd, J., Lang, R., Lilienfeld, S. O, … Odom, S. (2019). Rapid prompting method and autism spectrum disorder: Systematic review exposes lack of evidence. Journal of Autism and Developmental Disorders, 6, 403-412. https://doi.org/10.1007/s40489-019-00175-w
Reviewed by: Samantha J. Sellars, Master’s Candidate, and Frank R. Cicero, PhD, BCBA, LBA
Seton Hall University
Why research this topic?
It is estimated that 1 in 59 children from various backgrounds and socio-economic groups are diagnosed with Autism Spectrum Disorder (ASD). Deficits in social communication are a main component of this diagnosis. Researchers have found that 25% to 30% of individuals diagnosed with ASD will exhibit limited or no speech skills despite extensive intervention. To provide clients with ASD with a form of communication, augmentative and alternative communication (AAC) systems, such as speech generating technology, communication boards, and the Picture Exchange Communication System (PECS) are often introduced. However, other methods such as the Rapid Prompting Method (RPM) claim to teach text-based communication for people with developmental disabilities with significantly impaired communication. Soma Mukhopadhyay, the creator of RPM, claims that through her method, individuals with ASD start to communicate by being prompted to choose correct answers from two written options and then move on to communicating through a letter board where they are prompted to spell out words and sentences by pointing to printed letters. It is interesting to note that RPM resembles the discredited procedure known as Facilitated Communication (FC), another facilitator-dependent technique in which physical prompting is provided to individuals with disabilities as they select letters on a board to communicate. Similar to what has been shown with FC, facilitators using RPM may inadvertently influence the movements of the individual they are attempting to help or may interpret results as meaningful communication when they are not. Prior to the current study, Deacy, Jennings, and O’Halloran (2016) conducted the only published literature review on RPM. Although concluding that RPM could potentially have a beneficial impact on the symptoms of autism, significant flaws in the research procedures were noted. The study consisted of only three articles, had unclear review questions, did not outline inclusion criteria, omitted a review of study quality, and did not describe the literature search criteria used to find the articles. In order to help pediatricians, psychologists/psychiatrists, special educators, and families recommend and use only evidence-based practices, Schlosser et al. (2019) conducted a systematic review of the current RPM literature to determine the level of empirical support regarding its effectiveness.
What did the researchers do?
Schlosser et al. (2019) conducted a systematic review of all available literature that used RPM up until September 2018. A multi-faceted search procedure was used in which a multitude of peer-reviewed databases were employed to find all studies that reviewed the effectiveness of RPM. The researchers used detailed criteria for inclusion and exclusion of studies. Inclusion criteria required the study to have had at least one participant with ASD, used either a single-case experimental design or group experimental design, used RPM as the intervention, and been published in an English language, peer-reviewed journal. Researchers planned an investigation procedure in which a review team would code all the studies to determine the: (a) sample size, (b) participant demographics/characteristics, (c) intervention setting, (d) study design, (e) number of sessions per week, (f) fidelity of implementation, (g) types of outcomes targeted, (h) generalization, (i) maintenance, (j) interobserver agreement, (k) effect size for group designs, and (l) effect size indicators for single-case designs.
What did the researchers find?
108 unique articles were identified in the initial search procedure. After screening the titles and abstracts of these 108 articles, 102 were removed from further analysis because, although RPM was mentioned in the articles, the purpose of the articles was not to evaluate RPM as a treatment. The full text of the remaining six articles were reviewed; however, no study met the inclusion criteria. Several of the studies were rejected due to issues with the experimental designs, and several did not specifically study RPM as an intervention. This ultimately resulted in what is referred to as an “empty review.” In an empty review, no further analysis can be conducted due to a lack of literature that meets inclusion criteria. Therefore, the current systematic review yielded no scientific evidence for or against the effectiveness of using RPM to promote communication in individuals with ASD.
What are the strengths and limitations of this study?
Schlosser et al. was the first study to attempt a systematic review of the effectiveness of RPM. The authors convey that because no study could be included in the systematic review, there continues to be a knowledge gap with regard to the effectiveness of RPM when used with individuals with ASD. As a result, the researchers encourage future studies to thoroughly assess and document the communication levels of an individual before, during, and after utilizing RPM. The authors identified that the decision to only include studies published in English was a potential limitation of the study; however, they noted that their preliminary search had not resulted in any non-English studies.
What do the results mean?
Overall, the results of the “empty review” indicate that because there is no scientific evidence for or against using RPM with individuals with ASD, it is not close to receiving the status of an evidence-based practice. Therefore, the authors strongly discourage clinicians, educators, and parents/families of individuals with ASD from using RPM due to the lack of evidence. The authors caution anyone using RPM to remain aware of facilitator-dependency, where the facilitator may be influencing the result of the intervention. Proponents of RPM are strongly encouraged to publish studies with sufficient experimental rigor so that the effectiveness of RPM, if any, can be evaluated.
Citation for this article:
Sellars, S. J., & Cicero, F. R. (2020). Research synopsis: Rapid prompting method and autism spectrum disorder: Systematic review exposes lack of evidence. Science in Autism Treatment, 17(3)
