An experimental analysis
of facilitated communication

BARBARA B. MONTEE, RAYMOND G. MILTENBERGER, DAVID WITTROCK
(NORTH DAKOTA STATE UNIVERSITY)



Facilitated communication is a method of physical assistance to help an intellectually impaired person to communicate. The facilitator supports the hand of the client, who uses his index finger to point to letters on a letter board or to type on en electronic keyboard. According to Biklen and others, facilitated communication enables individuals with autism and those with other developmental disabilities to communicate, suggesting that they are not intellectually impaired. Other researchers, such as Wheeler, Jacobson, Paglieri, Schwartz and others, argued hat facilitator control of the typing was the most plausible explanation for the messages typed during facilitated communication sessions. Experiments in which clients who had demonstrated unexpected literacy were shown pictures and asked to type the names of the pictures using facilitated communication support this assumption. These experiments demonstrate that the name of the picture was typed in correctly only when the facilitator was shown the same picture. When the facilitator was shown a different picture or no picture at all, the client-facilitator pair never typed in the correct name. Also, when the facilitator was shown a different picture, the typed name was the one from the picture that the facilitator had seen and not the one that the individual with Autism had seen. Biklen in return criticized the results by supporting that too many experimental arrangements can make clients anxious, that testing destroys trust between the pair, that neither the facilitator nor the pair had received enough training and that the participants had aphasia.

Adressing Biklen’s commentaries, in the present study Montee et al analysed 7 client-facilitator pairs that had been using facilitated communication for 6 to 18 months. The clients were adults diagnosed with moderate or severe mental retardation with secondary diagnoses such as cerebral palsy, epilepsy, autism, attention deficit hyperactivity disorder or pervasive developmental disorder. They used two evaluation formats: describing activities and naming pictures.

They addressed the criticism raised by Biklen former in the following ways: 1) They used client-facilitator pairs that already had a lot of experience with facilitated communication. 2) A baseline condition was always conducted to establish successful communication and to make sure there are no word-finding problems. 3) The clients did not have to exactly name an object. It was also okay to describe it. 4) Anxiety and escape behaviours were measured in every experimental session. If such behaviour was measured, the experimental data were not used. 5) All sessions were conducted in their usual locations, at the usual time and with the usual facilitator in order to reduce the potential for anxiety or other negative reactions to the experiment. 6) Any time that the facilitator was not comfortable for any reason, the experimental trial was terminated.

The basic experimental manipulation was the control of the facilitator’s access to information about an activity or a picture. There were three experimental conditions: known (the facilitator had knowledge of the activity or the picture), unknown (the facilitator did not have knowledge of the activity or picture) and false information (the facilitator was given false information about the activity of picture).

In the activity format the client engaged in a familiar activity for about 5 minutes. Examples of activities included drinking coffee, looking at a magazine, eating soda crackers, playing cards and putting together a puzzle. Immediately after the activity the researcher either told the facilitator what the activity was (known), provided no information (unknown) or gave the facilitator information on an activity that did not take place (false). In the picture format the client and facilitator were shown the same picture (known), only the client was presented a picture (unknown) or the pictures presented to the client and facilitator were different. After the experimental trials the facilitators were asked to fill out a questionnaire that assessed the degree to which they believed that they influenced the facilitated communication during the experimental sessions.

The results show no great difference between the two evaluation formats naming a picture and describing an activity. The percentage of correct responses was high for all clients in the known condition and was at or near zero in the unknown and false condition. The results for the facilitator questionnaire show that the facilitators estimated that the clients performed better when the facilitator had knowledge of the correct answer, but they also estimated that the clients answered correctly more often than not in false and unknown conditions. They were convinced that the clients largely controlled the communication during sessions.

Due to these results three main conclusions were drawn from the study. First, consistent with prior research, facilitated communication did not lead to communication that came from the client. Second, the facilitators controlled the communication even though all of them believed that the client was authoring the messages. Regarding the issue of facilitator control it is noteworthy that there was a 23% refusal rate to answer in the unknown condition compared to refusal rates of 3% and 7% in the known and false condition. Also, when the facilitator did not have knowledge of the picture or activity, it took longer for most pairs to respond than in the other two conditions. A third conclusion is that anxiety and avoidance behaviours can not be counted as a reason for the failure to find facilitated communication, because only three of 320 trials were terminated due to such behaviour. Finally the fourth conclusion is that there was no difference in responses to the activity and picture scenarios. Therefore word-finding difficulties are no reason to question the validity of the results.

These results and the results of previous studies come to the conclusion that facilitated communication is not a valid means of improving communication, and therefore, should not be used. Those who continue using facilitated communication should consider the following implications: First, every message produced through facilitated communication should be verified through other means such as verbalizations or sign language. Second, the client and legal guardian should be informed of the risk of the facilitator’s influence when using facilitated communication. Third, it is important that other existing ways to communicate are not ignored in favour of facilitated communication.

Finally, facilitated communication for the first time led to the belief that persons with disabilities have more normal intelligence than thought. They were treated with more dignity and respect by their caregivers and family. Agencies must ensure that staff members continue to treat individuals with dignity and respect in the absence of facilitated communication.

For the summarization great thanks to Anne Burzinski.

To read the full study, please click here. JOURNAL OF APPLIED BEHAVIOR ANALYSIS, 1995,282189-200, NUMBER2 (SUMMER195)

To download the summary of the study please click here.

For the permission to post this study we thank Kathy Hill, Business Manager JABA