A psychologist overlooks the science and a journalist, the full story

 (Cross-posted at FacilitatedCommunication.org).

Part I: The Psychologist

When it comes to facilitated communication, Psychology Today has a mixed record. While a number of its contributors (Amy Lutz, Stephen Camarata, Bill Ahearn, and Scott Lilienfeld) have spoken out against it, others (Chantal Sicile-Kira, Robert Chapman, and Susan Senator) have, to one degree or another, expressed support. Recently joining the second cohort (which consists of a neurodiversity philosopher, an autism consultant, and an autism parent) is a psychologist: Debra Brause, PsychD.

Brause’s post, entitled Nina: A Nonspeaker Who Found Her Voice, showcases a nonspeaking autistic individual who purportedly describes her feelings of being locked inside and unheard by others until she started “using a method called spelling to communicate (S2C), which enables her to share her story.” S2C has also enabled Meehan’s communication partners to conclude that “she is a deep thinker and cares about ‘every single thing’” and also that she’s bilingual:

Not only did Meehan know English, but likely due to exposure to her grandmother’s native language, one day, Meehan spelled in Spanish, “I’m bilingual. I know how to speak Spanish, too.”

Brause is aware of the controversy surrounding facilitated communication (FC) and variants like S2C and RPM (Rapid Prompting Method). But she’s nonetheless confident of her claims. Nor are all of them unreasonable, as we see in her first two bullet points:

• Access to communication is a fundamental human right.

• Misconceptions about nonspeaking autism can be harmful.

Indeed; I think we can all agree on those.

But then come the next two bullets, which are, in fact, two harmful misconceptions about nonspeaking autism:

• Spelling to communicate (S2C) can be a powerful tool for nonspeaking autistic people.

• Neurotypicals should presume competence and become helpful communication/regulation partners to nonspeakers.

In fact, as a careful read through this website’s research pages (see here and here) will show, all the available evidence indicates that in S2C, as with all other forms of facilitated communication (FC), the facilitator, not the person with disabilities, is controlling the messages. S2C, thus, quite far from being a powerful communication tool for nonspeakers, is likely a major suppressor of their communication rights, as well as being a major detractor from evidence-based therapies that boost—however slightly—the ability of these vulnerable individuals to communicate authentic messages independently.

Additional harms can come from the specific messages and associated desires that are attributed to these individuals. Consider this:

Recently, Meehan met another local speller named Wynston. They started hanging out, and Wynston asked her to be his Valentine. They are forming a deep and loving emotional connection. Through spelling, they can fully express their feelings for each other, and they hope that other spellers out there know that they can build meaningful relationships, too.

What if Meehan actually has no interest in having a relationship with Wynston, and/or vice versa? What happens if Meehan and Wynston are forced to spend time together, even live together, against the will of one or both of them?

And what if Meehan actually has no interest in the causes that are attributed to her through her facilitated output and would rather be doing something entirely different:

She wants to create a school where spellers thrive. She is asking for neurotypicals to see what nonspeakers are capable of and give them the chance to have meaningful opportunities in society. She has created The Nina Foundation to educate the world about autism and raise awareness about autistic people’s ability to comprehend the world around them. According to Meehan, “There is a revolution happening through unlocking the voices of all nonspeakers.”

Nor is presuming competence the right move for neurotypicals who work with nonspeakers on communication—or, for that matter, for anyone who works with anyone on anything. If I were to presume that my special ed students are already competent, say, in understanding what constitutes an autism-friendly learning environment, I would do them (and their future students) a huge disservice. And if certain of my college mathematics professors hadn’t presumed, say, that we students were already competent in abstract math proofs, we all would have become better at constructing and applying these proofs on our own. What good teachers presume isn’t their students’ competence, but their capacity to learn what they don’t yet know.

Brause, however, is confident that we skeptics are wrong. One of her criticisms is that familiar straw man: “there is a common misconception that autistic nonspeakers do not have cognitive ability.” But it’s well known that autistic nonspeakers can excel in nonverbal tasks like puzzles, math, art, and music. What autistic nonspeakers don’t excel in is language. That’s because autistic nonspeakers—unlike nonspeakers with paralysis or deafness—are limited, by their very autism, in their automatic attention to voices and faces and in their ability to figure out the meanings of words.

Another of Brause’s criticisms repeats the “presume competence” fallacy:

When we assume that those without a voice are not verbal, we demean their capability and fail to uncover the intelligence they hold inside.

But the best way to uncover hidden intelligence in those without a voice is to provide evidence-based language instruction; not to assume that they’re already verbal.

Brause also repeats the popular but evidence-free pro-FC claim that apraxia impedes the ability to demonstrate comprehension and that S2C addresses this:

Due to apraxia, a motor movement disorder, many autistic people cannot demonstrate what they understand. Apraxia is a disconnection between the brain and the body, and autistic people often struggle to get their bodies to do what their minds intend. Nonspeakers cannot show their verbal acuity without the motor skills to convey their intelligence.

(For a discussion of why this claim is evidence-free, see this post and its follow-up).

Relatedly, Brause claims that S2C helps these theoretically apraxic individuals bypass their motor challenges:

Spelling to communicate teaches individuals with motor challenges the purposeful motor skills necessary to point to letters as a means of communication. The goal is to achieve synchrony between cognition and motor.

This claim, repeated though it is throughout the promotional material for S2C, is also evidence-free.

Another common pro-FC claim echoed here by Brause is that AAC devices are limiting:

The trouble with many AAC devices is that they are limited to icons and don’t represent natural speech. The devices rely on limited choices that can perpetuate motor loops (getting stuck on one icon or word) that may not reflect what the person really wants to say.

In fact, as we point out most recently here, most electronic AAC devices have ABC or QWERTY keyboard modalities that allow open-ended communication through independent, un-facilitated typing.

Interestingly, the only evidence that Brause cites for the validity of S2C is Jaswal et al.’s highly flawed eye-tracking study, and the only specific item she pulls from this article is the following undigested quote: “Our data suggest that participants actively generated their own text, fixating and pointing to letters they selected themselves.” For critiques of the study’s methodology and conclusions, see here and here.

Rather than citing any evidence that actually supports S2C—there isn’t any—Brause mentions its “rigorous training” and its “prompt hierarchy.” Alas, rigorous training does not a valid practice make. And prompt hierarchies, in the worlds of S2C and other FC variants, simply mean prompts that grow more subtle over time (as cues naturally do). Indeed, this notion is one of the biggest distinctions between FC and evidence-based therapies like ABA. In ABA, prompts are eliminated as soon as possible so that the person learns to perform the targeted skill spontaneously (e.g., communicating an unrehearsed message) without the therapist(s)/assistant(s)/facilitator(s) being present. While such independent, spontaneous performances of previously unmastered skills are routinely achieved in ABA, the same has never been documented in S2C or any other FC variants.

Brause’s other substitute for evidence, in particular for the claim that the S2C facilitator is “never influencing the content of the speller’s message”, is the movie Spellers. (For our critique of this highly problematic S2C documercial, see here).

Elaborating on the question of facilitator influence, Brause is convinced that S2C and RPM are essentially different from traditional FC:

The concern amongst skeptics is that the facilitator is the one conveying their own thoughts. Rapid prompting method (RPM) and S2C, however, differ from FC in that the facilitators do not typically support the child’s hand or arm and instead hold or move a letterboard.

It doesn’t seem to occur to Brause that prompts and letterboard movements (combined with facilitator judgments about which letters have been selected) are just as powerful at guiding messages as supporting a hand or arm. For examples of how this works, see, again, our review of Spellers.

Brause does acknowledge that the American Speech-Language-Hearing Association (ASHA) has a position statement against S2C—though she mentions only the second of ASHA’s two concerns, “lack of scientific validity,” and mysteriously omits its first concern, “prompt dependency.” Brause proceeds to suggest that what’s at issue is simply a lack of evidence and that this lack of evidence is merely the result of insufficient interest and insufficient funding:

This is an emerging field, and having sufficient research means having the necessary interest from the public and funding from large institutions.

Omitted from Brause’s discussion are the following points:

• Many of us are eager to conduct rigorous message passing tests on interested S2C practitioners; the lack of interest is on the part of practitioners, who uniformly refuse to participate in rigorous message passing tests.

• Rigorous message passing tests are the only way to determine who is authoring the messages and therefore whether S2C is (a) a valid mode of communication or (b) a communication-suppressing, human-rights-violating procedure.

• Rigorous message passing tests are inexpensive and do not require funding from “large institutions.”

In assuming that rigorous research has to be expensive, Brause may be thinking of Jaswal’s eye-tracking study, and/or his more recent flashing letters study, both of which use fancy equipment that might, to untrained eyes, lend a veneer of rigor to his work, but which actually bypass straightforward, reliable measures of authorship and instead generate highly indeterminate results.

Brause concludes by citing the criticisms on the pro-FC website United for Communication Choice of ASHA’s position statements against RPM and S2C as “flawed and dangerous,” singling out this quote from speech-language pathologist and “family communication coach” Gabriele Nicolet:

In ASHA’s own language, evidence-based practice includes the inclusion of people’s clinical and lived experiences. To deny someone’s lived experience and call it a hoax is the opposite of what that organization stands for. It’s abhorrent.

The answer that pro-RPM and S2C practitioners refuse to explore, of course, is the question of what is and isn’t indicative of a facilitated person’s lived experience.  And until we conduct rigorous message-passing tests to determine who is authoring the RPM and S2C-generated messages, that question will remain unanswered.

So will the question of whether Meehan actually wants to be in a relationship with Wynston.

Part II: The Journalist

When I first heard that Blocked and Reported, which bills itself as a podcast about Internet nonsense, was running a segment entitled Facilitating Communication (with Helen Lewis), I was hopeful that we’d finally have a wide-reaching, if somewhat offbeat, broadcasting of some powerful FC skepticism.

As it turns out, the show was somewhat of a missed opportunity.

The main problem was that journalist Helen Lewis, a staff writer at the Atlantic, limited herself to traditional FC and to events that occurred many years ago. When going over FC’s early history, Lewis got most of it right—although she referred to Douglas Biklen, who brought FC to the U.S. from Australia, as a “psychologist” and cited one of D.N. Cardinal’s early papers as having positive results for some individuals under controlled conditions (see our critique of that paper here).

Lewis did a pretty good job discussing the ideomotor (Ouija Board) effect and emphasizing the likelihood that FCed messages are entirely controlled by the facilitator—although she claimed, incorrectly, that “Some really did progress to independent communication.” She clarified that that this purportedly successful subset consists of those whose problem “was fundamentally a motor problem,” citing “locked-in syndrome” as her one example. But she added that “You can’t tell just from looking at someone whether they are one of the genuinely locked in people”—neglecting to clarify that “genuinely locked in people,” unlike most of the minimally verbal individuals who are subjected to FC, aren’t born that way and have typically been able to communicate independently prior to whatever injury locked them in.

Lewis went on to discuss such landmarks as the anti-FC exposé Prisoners of Silence, Janyce’s story as recounted in Prisoners of Silence and Janyce’s subsequent anti-FC activism (Lewis is highly appreciative of Janyce!); the pro-FC movie Autism is a World; Dan Engber's New York Times Magazine article about the Anna Stubblefield Case; and, finally, what seems to have been the impetus for this interview: the Anna Stubblefield movie that was released in the UK earlier this year and has yet to air in the U.S.

The closest Lewis comes to acknowledging the newer variants of FC is to discuss David Mitchell’s promotion of Naoki Higashida (The Reason I Jump). She rightfully calls Naoki’s communication a form of FC even though no one touches his arm, noting how suspiciously sophisticated his language is and how much it resembles all the other suspiciously sophisticated FC-generated messages she’s encountered.

But then Lewis suggests that FC is on its way out. She cites the renaming of the Facilitated Communication Institute at Syracuse University (now the Center on Disability and Inclusion), claiming that “it says it doesn’t advocate for things like FC, where there’s ambiguity regarding whether the client or the facilitator is the source of the message.” She apparently didn’t explore the Center’s website thoroughly enough to come across this page, which makes clear that FC is still very much a part of the Center’s activities. Instead, Lewis offers this: “I would say at this point that FC is pretty kind of trashed really.”

Nor does Lewis seem to have any idea of the latest variants of FC that are proliferating all over the country at what appears to be a geometric rate, thanks most recently to that documercial for S2C—which likewise goes unmentioned by Lewis.

Interestingly, Lewis concludes her interview by noting that journalists sometimes get things “catastrophically wrong”, and that, should she ever be caught doing that herself, “it will be a major test of character whether I’ve got the balls to just go ‘Nope, really spooned that one, absolutely sorry to everyone’.”

I’m rooting for Lewis to pass that test.

Autism Acceptance Month--what do we accept these days as autistic?

I fidget.

Clothing labels bother me.

I cover my ears to block out sirens.

I sometimes have trouble reading faces, following conversations, and knowing what to say.

Outside of my private refuges, I'm constantly masking my inappropriate reactions and urges and trying to pass as socially acceptable.

Socially demanding events tire me out.

So does lots of volume and sensory clutter.

I can get so absorbed in high-interest activities that I lose track of time and get highly distressed if interrupted.

I sometimes echo pithy things I heard earlier or "script" lines from movies and TV shows.

In other words...

I'm neurotypical.

And as a neurotypical person, I try to be fully accepting of autistic individuals, including of their right to communicate authentically without having their words, or their status as actually autistic, hijacked by others.

From Literacy to “Support Needs” to “Communication Boards”: How vague guidelines enable non-evidence based claims and practices

 (Cross-posted at FacilitatedCommunication.org).

When you write general guidelines, you need to make clear not just what you’re saying, but what you’re not saying. And to figure out which things, of all the things you’re not saying, you most need to emphasize as things you’re not saying, you need to take a look at who is likely—unwittingly or deliberately—to misinterpret what you’re saying, and in what ways.

In a 2021 article for the Brookings Institute, for example, education scholar Tom Loveless writes about how California’s 1987 English language arts framework got hijacked by the Whole Language movement, an ineffective, non-evidence-based mode of reading instruction that is responsible for much of America’s ongoing reading crisis:

The document did not mention whole language reading instruction, but true believers in that approach put their stamp on the state’s policies during implementation.

More recently, as Loveless reports, the equivocal writing in the 2010 Common Core standards, which aimed at a balance between Whole Language and traditional phonics, has resulted in something similar. In reality, there is no balance: non-phonics-based approaches (most especially the misnamed “Balanced Literacy,” with its “Three Cueing System”) continue to dominate reading instruction.

Here’s the takeaway: if governments want evidence-based reading instruction to predominate, their education standards need to explicitly state which types of reading instruction aren’t evidence-based.

Switching gears rather dramatically, a similar lesson applies to the DSM-5 criteria for autism. One of the most controversial changes in the DSM-5 was its elimination of Asperger’s. Asperger’s, the mildest form of autism, is now folded into what was now a three-tiered “Autism Spectrum Disorder.” The problem lies in how the DSM has defined those tiers, or levels:

• Level 1: “requires support”

• Level 2: “requires substantial support”

• Level 3: “requires very substantial support.”

Only in the fine print do we learn about the nature and purview of this support:

As is evident if you read past the first column, Level 1-3 support needs are defined, not in terms of the general requirements of daily living (organization, self-care, emotional regulation, and so on), but in terms of the two core symptom categories of autism: social communication deficits and restricted, repetitive behaviors. The levels, moreover, are a function of symptom severity.

For social communication/social interaction, for example, we have:

• Level 3: “severe deficits in verbal and nonverbal social communication”; “very limited initiation of social interactions”; and “minimal responses to social overtures from others.”

• Level 2: “marked deficits in verbal and nonverbal social communication”; “limited initiation of social interactions”; and “reduced or abnormal responses to social overtures from others.”

• Level 1: mere “deficits in social communication”; “difficulty initiating social interactions”; and apparently “decreased interest in social interactions.”

[Emphasis mine]

And for restrictive/repetitive behaviors we have, among other things:

• Level 3: “extreme difficulty coping with change” that “markedly interferes with functioning in all spheres”; and “great distress/difficulty changing focus or action.”

• Level 2: “difficulty coping with change” that “interfere with functioning in a variety of contexts”; “distress and/or difficulty changing focus or action.”

• Level 1: “difficulty switching between activities.”

The problem with this presentation is that, unless you read the fine print, it’s natural to assume that “support needs” means something much broader; that it includes support for any kind of need that might arise in the course of daily life—supports that might vary from day to day and from situation to situation. Supports for staying organized and keeping track of your things; for completing your assignments; for difficulties with emotional self-regulation; for fatigue and a need for frequent breaks. Support needs, in other words, that may be only indirectly or tangentially related to being autistic.

Because the DSM specifies the precise characteristics of autism support needs only in its fine print and doesn’t say explicitly what isn’t included as support needs, this much broader interpretation is precisely what some outspoken self-advocates have slapped onto it.  

Some self-advocates, for example, have characterized themselves as having high support needs because of organizational challenges, sensory sensitivities, anxiety, exhaustion after social events, and/or occasional meltdowns. Indeed, according to the Autism Self-Advocacy Network, “Support needs are just things autistic people need help with.”

But here’s the issue. Some of those who are diagnosed as Level 2 or 3 based on more severe core autism symptoms may actually have less anxiety and/or fewer organizational challenges and/or fewer issues with sensory fatigue than some of those who are diagnosed as Level 1, at least at certain times and/or in certain situations. This broadening of support needs beyond what the DSM actually specifies, therefore, both fuzzes up and twists around the autism spectrum.

Imagine a highly verbal individual who might once have been diagnosed with Asperger’s and who views herself as highly anxious or disorganized or easily overloaded with sensory stimuli—especially, say, in large social gatherings or at the end of a long day. This person can now claim to be "as autistic" as a nonverbal individual with profound challenges in social awareness and social reciprocity that affect him every moment of every day. Highly verbal but sometimes overwhelmed individuals who identify as autistic can now claim they have the standing to speak on behalf of their nonverbal counterparts. Finally, FC proponents can now claim that Level 3 autism doesn’t rule out linguistic sophistication, whether in those who are verbal but anxious and overwhelmed, or in non-to-minimal speakers—at least when those non-to-minimal speakers point to letters on held-up communication boards.

Communication boards, coincidentally or not so coincidentally, figure prominently in my final example of guidelines that aren’t sufficiently clear on what they’re not saying. These guidelines come in the form of two documents: a “Dear Colleague” letter from the U.S. Department of Education regarding the need for assistive technology (AT) in special education, and an accompanying document entitled “Myths and Facts Surrounding Assistive Technology Devices.”  Both of these went out on January 22nd of this year. The letter discusses the need for “AT devices and services for meaningful access and engagement in education” and adds that:

The use of AT devices and services is critically important for many children with disabilities as it can greatly improve their educational experience, improve their educational and post-school outcomes, and help develop important skills and abilities. These devices and services must be available, accessible, and appropriate for children with disabilities and their families. We all have a role to play in ensuring access to necessary AT devices and services for children with disabilities. Consider these examples of AT devices for children with a variety of disabilities.

The letter proceeds to list four categories of AT devices, one of which encompasses augmentative and alternative communication (AAC) devices. These are described simply as devices “to assist children with disabilities to communicate with teachers, peers, and their families.” The letter does not cite specific examples of what AAC devices are, let alone what they aren’t. Nor does the accompanying document, “Myths and Facts Surrounding Assistive Technology Devices.” But “Myths and Facts” does elaborate more on the larger category of AT devices, and here’s where the term “communication board” shows up:

Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability.39 Examples of AT include screen readers, adapted daily living devices (e.g., a toothbrush holder), and communication boards.

Unfortunately, however, “communication board” is ambiguous. If you look it up on Google Images, you see:

So far so good: these are all examples of evidence-based AAC devices that can rest on stationary surfaces and that allow users to independently communicate their own authentic messages by pointing to pictures, icons, or words.

But if you add the search terms “Spelling to Communicate” and “S2C” to the “communication board” search, here’s what you get:

Suddenly we see the familiar held-up letterboards of S2C.

And if you add the search terms “Rapid Prompting Method” and “RPM” to the “communication board” search, you get something similar:

That’s because advocates of the variants of facilitated communication known as RPM (Rapid Prompting Method) and S2C (Spelling to Communicate) regularly use the term “communication board” for the letterboards that facilitators hold up to the index fingers of their non-speaking, Level 3 autistic clients.

So the U.S. Department of Education, by failing to specify which sorts of devices are and are not legitimate AAC devices, and by inserting the word “communication board” into its supporting document, provides an opening for supporters of RPM and S2C to claim that the U.S. government is calling for the use of RPM and S2C in schools.

And guess what? Just three days after the release of the Department of Education documents, the disability news journal Disability Scoop released an article entitled “Ed Department Warns Schools Not To Overlook Assistive Technology In IEPs” which opens as follows:

It’s hard to read the caption below the picture, but this is its first sentence: “Mitchell Robins, right, who has autism, points to letters to form words that therapist Anthony Bartell can write down to draft a blog post.”

The article makes no mention of S2C, RPM, or communication boards, and it only mentions AAC in the abstract. Those in the know, however, will instantly recognize in the caption and accompanying image all the tell-tale signs of S2C or RPM, and, in case there’s any doubt left, a quick Google search confirms that RPM is the methodology to which the pictured individual is being subjected.

In faulting the U.S. government and the DSM for being insufficiently clear about what they’re ruling out—whether it’s the Three Cueing System, a generic notion of support needs, and/or all variants of facilitated communication, hijacking all as these variants are of authentic communication—I’m assuming, of course, that the lack of clarity was inadvertent. But in the last case, the rapidity with which the release of the government documents gave rise to a celebratory article showcasing an RPM user (albeit while abstaining from all references to RPM or any other form of facilitated communication)—well, that one has me wondering.

Given how cozy certain sectors of the U.S. government have gotten with the FC lobby (see also the  platforming of FC last year by the National Institutes of Health at the National Institute of Deafness and Communication Disorders webinar on nonverbal individuals with autism, and the inclusion of facilitated individuals as members of the U.S. Department of Health and Human Services Inter-Autism Coordinating Committee), I can’t help but wonder if the inclusion of the word “communication board” in the U.S. Department of Education’s “Myths and Facts Surrounding Assistive Technology Devices” was somehow, shall we say, strategic.

Facilitated messages attributed to different people show distinctive styles, but this fails to rule out complete facilitator control

 (Cross-posted at FacilitatedCommunication.org).

I got so distracted with other pro-FC developments that have emerged since last August—Angie Kim’s Happiness Falls, Jennifer Binder-Le Pape’s purported myths about RPM/S2C, Vikram Jaswal’s latest pro-S2C paper, and some half-dozen other developments—that I’m only now getting to the second of two papers published this past year by Nicoli, Pavon, Grayson, Emerson, and Mitra, the first of which I critiqued here at the end of August.

As with Nicoli, Pavon, Grayson, Emerson, and Mitra (2023), this second paper, (Nicoli, Pavon, Grayson, Emerson, Cortelazzo, and Mitra, 2023), focuses on touch-based facilitated communication (FC) as used with individuals with cognitive and sensorimotor disabilities. (The individuals’ precise diagnoses and measured language skills remain unspecified). The authors’ other paper provided a highly quantitative task analysis of the sensorimotor skills involved in sitting in front of a keyboard and pointing to letters; this paper provides a highly quantitative stylistic analysis of a database of facilitated messages in Italian. Its goal is to explore who authored these messages—the facilitator, the facilitated person, or some combination of both.

This article purports to build on other analyses of facilitated messages that have found the texts of the facilitated individuals (or facilitatees) to differ stylistically from those of their facilitators—particularly in the more frequent appearances of unusual words and neologisms (made-up words). Such differences, the authors acknowledge, are not proof of authorship by the facilitatees (they cite Saloviita, 2018). And it’s impossible to know, they concede, what the facilitatee’s texts would look like, stylistically speaking, without the assistance of a facilitator, since none of the facilitatees can type independently. But the authors nonetheless insist that such a quantitative study can potentially answer questions about authorship.

Of course, there’s a much simpler, more definitive procedure that can answer—and has answered—that question: the controlled message-passing experiment in which the facilitator is blinded to the answers to the questions asked of the facilitatee. Dozens of such message-passing tests were conducted back in the 1990s, some 25 to 30 years before this article was written, beginning shortly after FC was introduced to the United States in the late 1980s. The answer was total facilitator control. The facilitators were the sole authors of the facilitated messages.

Despite this, FC persists, and Nicoli, Pavon, Grayson, Emerson, Cortelazzo, and Mitra (2023) open by introducing it. The authors describe FC as a technique used with people with a combination of “atypical cognitive capacity” and “sensorimotor coordination deficits” to “physically support them, for example, by touching their torso or arm as they type.” The authors add that “The neurophysiological mechanism of such motor assistance for linguistic expression is not known.”

Given what all the rigorous studies of FC have shown, namely that the literate facilitator is controlling the messages by directing and cueing (however unwittingly) the facilitatee, “not known” is bit of a stretch.

It’s not that the authors are unaware of this possibility: they acknowledge that the prevailing view among experts is that of total facilitator control via facilitator cues. But they insist that it’s just one theory about what’s happening, and they proceed to propose that the facilitative touch could serve, not to cue and control, but instead to help to reduce the “cognitive load” of the facilitated person. Their only evidence for this is their other 2023 article—the one I critiqued here.

While the authors also acknowledge the results of the message-passing tests of the 1990s, they also cite the various “alternative” tests that message-passing-averse researchers have conducted since then: measurements of eye-gaze fixations on letters (Jaswal et al., 2020); measurements of index-finger accelerations towards letters (Faure et al., 2021); and linguistic analysis of facilitated output (Bernardi & Tuzzi, 2011; Niemi & Kärnä-Lin, 2002; Tuzzi et al., 2004; Tuzzi, 2009). (For our critiques of these articles, see here and here). These various studies, the authors claim, create a more “complex picture” of what’s going on and suggest some involvement of the user (the facilitatee) in creating the message. Stylistic analysis in particular, the authors claim, allows for

a time-extended perspective on the text construction process as it operates naturally, without the insertion of experimental artifacts. The analysis of text generated over long periods of time, while the user and their partnership with facilitators evolve, provide a stronger test of individual influences than snapshot methods using arbitrary tasks in which the user possibly is not motivationally invested.

The authors do not elaborate. In particular, they don’t tell us what sort of “complex picture” or longitudinal text analysis, on one hand, or experimental artifacts, snapshot methods using arbitrary tasks, or lack of motivational investment by the facilitatee, on the other, could possibly account for the common outcome, seen in the rigorous message passing tests of the 1990s, of facilitatees typing out information to which only the facilitator had access—e.g. a picture of a key instead of a flower.

What other explanation there could possibly be—other than the simple, straightforward explanation that the facilitator is the one controlling the messages—is hard to imagine.

Despite their express reservations about this simple explanation, and despite the pro-FC track records of some of their co-authors (see Emerson et al., 2001; Grayson et al. 2012), the authors assure us that “we start from the maximally sceptical position that the facilitator is the sole [authoring] agent”. They proceed to claim that, if the facilitator is the sole author

It should not be possible, then, to find unique stylistic fingerprints associated with specific FC users.

Operating under this purportedly well-founded assumption (more on that shortly), and under their purportedly maximal skepticism, the authors set out to investigate whether children with developmental disabilities “exhibit their own stylistic signatures alongside those of their facilitators.” They look both at whether keeping the facilitator constant across different facilitatees results in one style or many; and at whether keeping the facilitatee constant across multiple facilitators results in many styles or one.

As with Jaswal et al. (2020), Faure et al. (2021), Nicoli, Pavon, Grayson, Emerson, and Mitra (2023), and Jaswal et al. (2024), it would have been orders of magnitude simpler to measure authorship through rigorous message-passing tests. And it would have been orders of magnitude simpler to measure literacy skills through direct assessments of literacy skills (can the facilitatee place the “key” label, say, on a picture of a key, and the “flower” label on the picture of a flower?). Instead, what we get is yet another fancy study: “a multi-level quantitative linguistic analysis” complete with “unsupervised machine-learning methods, particularly cluster analysis.”

Cluster analysis from Nicoli, Pavon, Grayson, Emerson, Cortelazzo, and Mitra (2023)

And what do the multi-level quantitative linguistic analysis, unsupervised machine-learning methods, and cluster analysis show? “[T]hat the users’ stylistic signature is detectable alongside that of facilitators.”

The authors’ conclusion? The texts are co-authored: co-created by both the facilitatee and their facilitator:

The results clearly show that texts written via FC generally present two linguistic imprints: the user and the facilitator. Based on this result, FC is better described as a co-creation process in which two distinct and active participants collaborate in the production of linguistic content.

Here the authors acknowledge, but claim to rule out, the obvious alternative explanation: namely, that the facilitator is subconsciously channeling the imagined writing style of an imagined persona that they’ve projected onto their facilitatee. In fact, this is arguably the most plausible way in which facilitators concoct the messages that they unwittingly facilitate.

But Nicoli, Pavon, Grayson, Emerson, Cortelazzo, and Mitra suggest that this simply isn’t possible, especially given that one of the facilitators in the study facilitated 10 different individuals (the other two involved in the study facilitated six and four respectively). They seem to think that facilitators are somehow facilitating these multiple individuals “simultaneously” and that there’s a limit on how many different personas one can imagine and subconsciously channel. They also seem to think that facilitators are incapable of coming up with different styles on their own and instead would need to have “external models”:

[N]o studies have so far demonstrated the possibility of imitating more than one style simultaneously. This hypothesis, while logically possible, requires demonstration. Besides, even if we assume that facilitators consciously manipulate their style such that statistical models end up attributing texts to users instead, and also that facilitators can maintain up to ten different stylistic systems and use them in the correct contexts, we must contend with the issue of stylistic models…. However, in the case of FC, facilitators have no external models to which they can refer, so it is unclear on which basis they would organize their imitation.

Novelists, among other people, would beg to differ. Would Nicoli, Pavon, Grayson, Emerson, Cortelazzo, and Mitra admit, say, The Moonstone or Dracula or The Color Purple as demonstrations of the possibility of imitating more than one person’s (character’s) style?

Confident that they’ve dispensed with the alternative explanation for their results—facilitators channeling the imagined personas of their facilitatees—the authors draw further conclusions:

• “FC users possess a level of literacy skills, which any AAC intervention should seek to nurture and develop to improve users' quality of life.”

• “As the user is clearly a participant in text generation, there is scope for touch-based assistance to serve as a scaffold in DD individuals' linguistic development, and to contribute positively to their quality of life and connection with carers.”

• “Whether the individual does, or could develop to, generate typed text independently should not determine the value of practising and better understanding touch-assisted typing techniques.”

The authors seem unconcerned with the disturbing implications of life-long dependence on others for communication—especially communication that must be co-authored by those others. Such dependence, fortunately, is bypassed by most legitimate forms of AAC.

But the authors, like other FC proponents, repeatedly characterize FC as a form of AAC: one specifically for those with a combination of sensorimotor and cognitive disabilities. Referencing their other article (Nicoli, Pavon, Grayson, Emerson, and Mitra, 2023), the authors suggest that the issue for such doubly-disabled individuals isn’t a lack of linguistic skills, but of challenges involving cognitive overload and planning difficulties that the facilitator’s contact on the facilitatee’s arm or torso somehow ameliorates. Linguistic skills, purportedly, are intact, and facilitation serves to unlock them, providing

cognitive simplification by reducing the cognitive demands of formulating a full-language expression… or by reducing the overall cognitive demands of the task by supporting attention, providing emotional reassurance and reducing the cognitive demands of the co-occurrent motor task while maintaining text-based communication…

As I’ve discussed in earlier posts, for example here, this is at odds with decades of rigorous research on the autistic minimal-to-non-speakers who constitute the majority of people subjected to FC.

Second, the authors cast FC as a form of scaffolding. But scaffolding, by definition, is something that (1) supports something—i.e., existing skills and (2) will eventually be removed—i.e., when existing skills reach mastery.

Third, they characterize FC as a teaching aid. But they don’t say what it’s teaching. What could it possibly be that facilitators are instructing the facilitatees by touching their arms or torsos?

Then there’s the problematic notion of co-authored messages: messages, that is, that are purportedly co-constructed by the facilitator and facilitatee. On one hand, the authors acknowledge that who constructs what is unclear from their data/results:

The nature of the corpora and these methods do not allow us to discern the details of what originates with the user and the facilitator. The scope of these analyses is at the stylistic level with no presumption nor power to distinguish facilitators' traits from users' features on a sentence-by-sentence basis. Also, these analyses do not allow any comment on how the facilitator influences and supports the user. These questions require other methods and task-oriented analyses. What the present results clearly show is that the user is not linguistically passive, and the facilitator moulds rather than wholly constructs the typed text.

In addition, they acknowledge that:

Co-authorship does not offer certainty that a message written by integrating two linguistic sources fully mirrors the FC user's own intention.

But then, noting that what was most stylistically distinct about the facilitated messages of given facilitatees were their unusual word choices, they hypothesize that the facilitatees supplied the content words and the facilitators supplied the syntactic and morphological framework:

[The] facilitators create syntactical structures within which users can fill in their own content… Syntactical scaffolding by the facilitator may also involve adjusting morphological endings, suggesting linkers or auxiliary verbs, or providing syntagmatic prompts to help begin communication (e.g. “I think that …”, or “I feel that …”)…. In this respect, the facilitators' work would be comparable to that of editors.

How one person supporting the arm or torso of another person promotes this kind of division of linguistic labor (content words vs. syntax), editing (adding and adjusting of endings and function words), and syntagmatic prompting is left unsaid. Such a linguistic cooperation/co-construction, if that’s actually what’s going on, is unlike anything seen in any other interpersonal collaboration anywhere else on planet Earth.

What’s much more likely is that the collaboration, if that’s the right word for it, operates at the level of individual letters. Sometimes the facilitatee manages to hit an unexpected letter, and the facilitator’s non-conscious response is to cue one of those unusual words or neologisms so often seen in FC.

Actual communicative collaborations, of course, involve conscious behaviors. Given this, if the authors were truly convinced that that was what was going on and genuinely curious about who was contributing what, why didn’t they simply query the facilitators? Why didn’t they dispense with all the quantitative cluster analyses and post-analytical speculation and simply ask them, directly: “Which parts of the sentence did you contribute and which parts did you leave up to the facilitatee?”

Better yet, talk the facilitators—and yourselves—into doing a simple, straightforward message-passing experiment.

REFERENCES

Bernardi, L., & Tuzzi, A. (2011). Analyzing written communication in AAC contexts: A statistical perspective, Augmentative and Alternative Communication, 27:3, 183-194 DOI: O.3109/07434618.2011.610353

Emerson, A., Grayson, A., & Griffiths, A. (2001). Can't or Won't? Evidence relating to authorship in Facilitated Communication. International Journal of Language and Communication Disorders, 36, Supplemental: 98-103. DOI: 10.3109/13682820109177866

Faure, P., Legou, T., and Gepner, B. (2021). Evidence of Authorship on Messages in Facilitated Communication: A Case Report Using Accelerometry. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2020.543385

Grayson, A., Emerson, A., Howard-Jones, P., and O’Neil, L. (2012). Hidden communicative competence: Case study evidence using eye-tracking and video analysis. Autism. 16 (1); 75-86. DOI: 10.1177/1362361310393260

Jaswal, V.K., Wayne, A. & Golino, H. (2020) Eye-tracking reveals agency in assisted autistic communication. Scientific Reports 10, 7882. DOI: 10.1038/s41598-020-64553-9

Nicoli G, Pavon G, Grayson A, Emerson A and Mitra S (2023) Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities. Frontiers in Integrative Neuroscience 17:1181025. doi: 10.3389/fnint.2023.1181025

Nicoli G, Pavon G, Grayson A, Emerson A, Cortelazzo M and Mitra S (2023) Individuals with developmental disabilities make their own stylistic contributions to text written with physical facilitation. Frontiers in Child and Adolescent Psychiatry 2:1182884. doi: 10.3389/frcha.2023.1182884

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Saloviita T. (2018). Does linguistic analysis confirm the validity of facilitated communication? Focus Autism and Other Developmental Disabilities, 33(2):91–9. doi: 10.1177/1088357616646075

Tuzzi, A., Cemin, M., & Castagna, M. (2004). "Moved deeply I am" Autistic language in texts produced with FC, Journées internationales d’Analyse statistique des Données Textuelles, 1097-1105

Tuzzi, A. (2009). Grammar and lexicon in individuals with autism: A quantitative analysis of a large Italian corpus, Intellectual and Developmental Disabilities, 47:5, 373-385 DOI: 10.1352/1934-9556-47.5.373