Facilitated Communication: Sifting the Psychological Wheat from the Chaff
In the early 1990s, an educational treatment program was spreading like wildfire all over the U.S. and Canada. This program, known as facilitated communication, promised to revolutionize the way people treated debilitating conditions such as autism and profound mental retardation. The idea behind facilitated communication was that many people with autism or severe mental retardation actually possess normal levels of intelligence. The problem, advocates of facilitated communication argued, is that these conditions simply prevent people from expressing themselves (because of verbal or motor deficits). If you could read the mind of a person with severe autism, the argument went, you would discover a person who could read at a high level, express sophisticated emotions, and even write a touching essay about the pain and isolation of living with autism.
Could this be true? Advocates of facilitated communication thought so, and they produced what initially appeared to be remarkable evidence in favor of their position. Autistic and mentally retarded children began to express themselves in profound ways. They did so with the assistance of facilitators - whose job it was to steady the hands of the disabled communicators while they typed or pointed to keys on a letter board. Story after story emerged about mentally disabled persons who, with the aid of a facilitator, began to express themselves in amazing ways. People diagnosed as autistic or retarded scored well on standard IQ tests, wrote brilliant essays, and even composed poetry.
Unfortunately there was a problem. Researchers who observed the facilitation process sometimes observed that those who were presumably being facilitated often answered questions when they were not looking at their typewriters or letter boards. Controlled scientific studies also revealed that if one posed a simple question to a child with severe autism, the child could only answer the question when the facilitator knew the answer. For example, if the facilitator could not see a simple object that the child was asked to name, the child could not name it. Highly trained facilitators who had elicited sophisticated answers from their patients in the past could no longer do so when they were prevented from knowing what the patients were being asked.
The short version of this long story is that study after study showed that facilitated communication didn't really work. Apparently, the positive results that had generated so much enthusiasm were the results of a subtle process in which well-intended facilitators were answering questions themselves - without any awareness that they were doing so. Based on the findings of carefully controlled studies of facilitated communication, the American Psychological Association issued a resolution in 1994 that there was "no scientifically demonstrated support for its efficacy."
Significance and Practical Application
As a result of the APA statement (and similar statements from many other scientific organizations), most schools and treatment centers stopped using the technique in the mid 1990s. Perhaps the saddest part of this story is that the most vocal advocates of this technique continue to use it and insist that it is effective — despite the disconfirming evidence. As one parent said, even if the technique is merely an illusion, it is an illusion that they wish to continue.
This scientific episode offers a positive lesson: If psychological research does not always give us hoped-for answers, it does help us sift potent reality from wishful thinking, and thus to focus our energy on real solutions. There is no magic wand that one can wave to make profound disabilities disappear. However, as researchers continue to investigate why serious disabilities occur, and how they can best be treated, there is good reason to be hopeful for better prevention and treatment in the future.
Moore, S., Donovan, B., & Hudson, A. (1993). Facilitator-suggested conversational evaluation of facilitated communication. Journal of Autism and Developmental Disorders 23, 541-551.
Mostert, M.P. (2001). Facilitated communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders 31, 287-313.
Szempruch, J., & Jacobson, J.W. (1993). Evaluating the facilitated communications of people with developmental disabilities. Research in Developmental Disabilities 14, 253-264.