Does facilitated communication have a place in the world of autism? The biggest debate has been over who is doing the communicating, the nonverbal individual, or the facilitator? Over the years, questions have been raised about the effectiveness of facilitated communication in nonverbal children with autism and other conditions.
This article will cover what facilitated communication is, the history behind it, how it’s used for children with autism, whether it is beneficial for nonverbal children with autism, and the pros and cons of its use in autism.
What is facilitated communication?
Facilitated communication (FC), is an augmentative and alternative communication (AAC) approach used to assist nonverbal individuals with disabilities to express themselves through typing, writing, gesturing, or pointing. There are three main categories of AAC: non-tech, aided low-tech, and aided high-tech. FC falls under the aided high-tech category. Likewise there are three main types of AAC that fall within these categories (writing, pointing, and signing).
Origination and history of FC
The idea for the FC approach originated in Australia. Rosemary Crossley is credited as being the creator of this technique back in the 1970s, while she was working with severely disabled individuals. She assisted a woman with cerebral palsy to become capable of communicating by supporting her index finger to point at letters to help her read and write. In the late 1980s, Crossley instituted facilitated communication to a center that aimed to help individuals with speech impairments communicate.
Douglas Biklen was impressed and intrigued by the method that Crossley developed, so he took a trip to Australia to witness the technique firsthand. By the mid-1990s, Biklen had introduced the approach in the United States.
What is facilitated communication used for?
FC is used to help nonverbal children with conditions such as autism, cerebral palsy, down syndrome, and various disabilities and communication impairments, express their thoughts. The ultimate goal behind FC is to encourage independent communication by supporting movement difficulties. The concept is to make communication easier for those that need a communication aid that is portable, and addresses the issue of not being able to effectively use their hands. Some professionals refer to FC as Facilitated Communication Training (FCT). However, the purpose behind FCT is to encourage individuals to make choices so that they can benefit from the use of communication aid, such as keyboards, picture boards, and/or speech synthesizer.
How does it work?
The person providing assistance is called a facilitator or a communicator. The technique involves a facilitator or communication partner assisting the speech impaired individual using a keyboard to communicate. This person aids the autistic individual by providing support to their hand or pointer finger to type words on a keyboard.
Is facilitated communication beneficial for children with autism?
Supporters of FC believe that it can be beneficial for children with autism who have speech impairments. Supporters of this approach feel it provides a voice for children who do not have one. They believe that FC provides benefits beyond encouraging independent communication. Autistic children with speech impairments are able to express their wants and needs through an approach that is easier for them to understand and manage.
Those who stand behind the effectiveness of FC claim that autism is a physical impairment rather than a developmental impairment. They believe that speech impairment in a nonverbal autistic child can be resolved through the use of physical support. However, some members of the scientific community are opposed to this way of thinking, because a child with autism might have learning disabilities that need to be addressed to help them communicate.
Facilitated communication is dismissed by some medical experts as being ineffective for nonverbal children with autism, and they state it can be replaced with other forms of treatment and therapy.
Some recent studies that have concluded the FC approach does not meet the needs of nonverbal children. According to the American Psychological Association(APA), in some of the studies the speech impaired individual is “disengaged.” This leads to the questioning of where the communication is stemming from when physical intervention is involved.
- The nonverbal child receives physical and emotional encouragement to communicate
- Encourages individuals to desire and achieve independence
- Some individuals have difficulties concentrating with the addition of background noise
- Some experts believe children are less likely to open up or improve communication when using FC
- The use of FC might be abused or manipulated by a facilitator
- There’s no proof that these are the thoughts of the speech-impaired individual
- The training is time-consuming
- Some professionals say FC is limiting and difficult to utilize
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Most of the scientific research studies are aimed at children with ASD that are aged three and older. Not much research is provided for individuals under the age of three because most children are not diagnosed with ASD until they are over the age of two, according to medical experts.
For children under the age of three, augmentative approaches that are implemented in developmental plans might include picture cards and American Sign Language. The use of facilitated communication is often done through prompting and supporting fingers, hands, and wrists to point at pictures and objects. However, many professionals shy away from use facilitated communication for children this young.
Alternatives to facilitated communication
There are a number of ways that nonverbal autistic children can learn to use to communicate their wants and needs with others. The majority of children on the spectrum are visual learners, which is why it’s often recommended to use an augmentative alternative communication approach.
According to the National Institutes of Health, sign language is the most advantageous form of AAC, followed by picture cards. An analysis was performed on verbal behavior and it was concluded that sign language is the form of AAC that is the most parallel to speech. However, the form of AAC that is the most trending is facilitated communication. An individual can use a variety of communication mechanisms, based on the person that they are communicating with and their environment.
Here is an in-depth look at some alternative methods that are used in ABA, speech, developmental, and/or occupational therapy to encourage communication in a speech impaired autistic child.
American Sign Language
According to the Center for Autism Research (CAR), the use of sign language enhances children with autism’s ability to express themselves. Along with picture cards, it is one of the most effective strategies used among nonverbal autistic children. It incorporates the use of hand gestures, facial expressions, and body language that “helps generate verbal language”.
A speech pathologist (SP) focuses on the mechanics of speech. The SP will encourage the individual to understand sounds and put them together to form words, and from there forming sentences and combining words. They will develop a plan for your child based on his/her needs.
Pictures cards are commonly referred to by the popular trademarked name PECS (Picture Exchange System). These are basically flashcards with images that symbolize or represent different feelings, needs, and wants. The picture card approach should be done in phases. The first phase is familiarizing the child with the images on the cards. Eventually, through continued use, the child might be able to form sentences.
Picture cards are a preferred method of communication training because it can be used and understood universally. Other forms of AAC can potentially misconstrue the thoughts of the autistic individual.
After reading this article, you should have a firm grasp on the topic of facilitated communication. Is it beneficial to children with autism? Before the question is answered let’s review some key points:
- The goal behind FC is to provide a means of communication in nonverbal individuals with disabilities
- According to the American Psychological Association and the American Academy of Pediatrics, there is a lack of proven success with this approach
- Some cases of abuse allegations have arisen from the use of facilitated communication
- There are other successful forms of AAC that can be used with speech impaired autistic children
- Sign language is often said to more effective than FC
- Some experts believe that the person typing is typing the facilitator’s thoughts and not his/her own thoughts
With all this in mind, is FC beneficial? It depends on the person. Not every approach is going to work the same with every child. There is not a one-size-fits-all approach to overcoming speech impairments. Should FC be the first approach to use with nonverbal autistic children? It seems the answer is “no, it should be used as a last resort”. The most effective strategy might be to use a combination of methods and approaches.