An FC Primer

We continue to meet people who are new to Facilitated Communication or, perhaps, thought it died out in the mid-1990s, so today’s blog post is an introduction to current-day FC.

Images of Facilitated Communication use from various YouTube videos, training videos, and pro-FC movies demonstrating facilitator holds during the typing sessions.

Before describing FC, here are some key points:

1)    There is no scientific evidence that the use of FC produces independent communication. In fact, controlled studies indicate facilitator influence and control over the typing activity. (See Controlled Studies and Systematic Reviews)

2)    The technology used in FC (e.g., paper or plastic letter boards, keyboards, other communication devices) is not the problem. Legitimate, evidence-based methods may employ each of these in one way or another. The problem with FC is the assistant’s interference with the communication process.

3)    FC is not recognized as a legitimate form of Augmentative and Alternative Communication (AAC) because the assistant’s behavior impedes the user’s ability to communicate independently. FC builds dependence on the assistant which is the antithesis of AAC.

4)    While proponent literature often refers to just one organization, the American Speech-Language-Hearing Association (ASHA), as having position statements against FC, the list is much broader. Because most pro-FC sites fail to provide their readers with a complete list, we’ve compiled one here.

Proponents believe emotional and physical support alone can unlock hidden literacy skills in their clients or loved ones. They persist in their use of FC without providing proof that the typed messages are independent and free from facilitator control.

The people providing support during FC were, originally, called facilitators. There is no unified regulatory or licensing board that oversees this group.

Proponents also call themselves by the following: interpreter, support assistants, communication assistants, and “communications and regulation” partners. With these alternative names for facilitators, it is important, in viewing FC sessions, to pay attention to facilitator behavior, rather than put too much stock into what they call themselves.

Facilitators cue their clients physically and vocally, and thus exert control over the typing activity. This cuing, often inadvertent, is associated with the ideomotor phenomenon, which has been linked to automatic writing, dowsing, use of the planchette or Ouija board, and the like.

Proponents practice FC in two primary ways, though one hybrid variant called “Speaking with Eyes” needs its own blog post.

“Traditional” facilitated communication is also known as supported typing, typing to communicate, saved by typing, hand over hand, informative pointing, and possibly others.

“Traditional” FC involves facilitators holding the wrist, elbow, shoulder, back, or leg of the client. Some facilitators also hold clients’ clothing at the sleeves, bottom of the shirt, pant leg or the like. Cuing occurs when facilitators move their fingers, tense their bodies, tilt their heads, provide vocal cues (e.g., changes in breath, vocalizations), tug on clothing, or otherwise motion the client to move their hand to a particular area of a keyboard and/or stop and push down on a desired letter. These signals, particularly in facilitators who’ve practiced this technique for years, can be subtle and barely noticeable to the naked eye. The best way to detect (e.g., rule in or rule out) facilitator control over the typing is double blind testing, a form of testing that proponents aggressively avoid.

Rapid Prompting Method (RPM) is a variant of FC. Alternative names for RPM are Spelling to Communication (S2C), motor communication, and possibly others.

RPM or S2C involves facilitators holding the letter board or communication device in the air. The client may appear to be pointing independently to the letter board (e.g., the facilitator does not generally hold on to the person’s wrist or other body part), but relies on the facilitator for letter selection. Along with cuing seen in “traditional” FC, facilitators can be seen moving the board (e.g., up, down, backwards, forwards) to optimize letter selection. Again, testing is aggressively avoided.

Red flags that facilitators may be controlling the typing session include, but are not limited to the following:

1.     The facilitator maintains eye contact with the letter board during the typing session, but the client does not.

2.     Rate of letter selection is too rapid for the facilitator to process in a reasonable time.

3.     Client speaks words or phrases that are different to those being typed.

4.     Typed messages result in unexpected literacy skills (e.g., beyond the education experiences of the client). Facilitators often claim the clients learned how to read and write by watching television, listening to the radio, or being exposed to books or magazines in their environment. Literacy skills need to be taught and are not innate.

5.     Clients do not appear to understand how to interact with the letter board, keyboard, or communication device without the facilitator present. They may or may not know how to identify letter names  or how to combine letters to formulate words without the facilitator present.

6.     The facilitator controls the stop and start of typing by offering or pulling the letter board away from the client.

7.     The letter board moves in the air during the typing session, optimizing letter selection.

8.     The client (as seen when translucent boards are used) points in between letters or parts of the board that do not correspond with the letter(s) called out by the facilitator.

9.     The facilitator provides hand or arm signals by moving their arm (the one not holding the letter board) to correspond with desired letter selection.

10. Hunt-and-peck style or one finger typing, especially combined with the client’s inconsistent attention (eye contact) with the letter board.

Individuals with severe communication difficulties deserve access to legitimate, evidence-based methods and techniques to optimize their potential as independent communicators. FC is premised on facilitator influence and control, with no viable way to extricate the facilitator’s behavior (e.g., cuing) from the typing session. FC is not and never has been proven as a viable option for independent communication and, to quote the title of a 2018 article about this topic, “It’s time to stop exposing people to the dangers of facilitated communication.”

 See our blog index here for further critiques, reviews, and updates.