Facilitated Communication Isn't

by Brian Dunning
May 10, 2022

It's truly unfortunate that there are people out there who have intelligence but are without the ability to communicate — perhaps they have severe cerebral palsy, autism, or some other communication disability. It's hard on them, and just as hard on their families and loved ones, who aren't even able to know something as basic as that the person is cold, hungry, has an itch, wants to change the channel on the TV, or maybe just wants to say "I love you." And so, we see the same thing that happens every time there is a difficult and painful problem for which we don't have a good solution: charlatans step forward to fill the void. In this case, it's called facilitated communication: a facilitator sits with the disabled person, holds or guides their hand, and "assists" them to type on a computer keyboard or tablet, or tap some icon. The idea is that the disabled person just needed that little extra bit of support or assistance. Suddenly their whole world is opened up to full, speedy, fluent communication — so long as the facilitator is there to help. The only problem with it is that it's completely fake.

It's not just fake, it's astoundingly fake. Many formal tests have been done and all have found that any communication is coming from the facilitator, and not from the disabled person. The way we test facilitated communication to see who the communication is really coming from is quite simple: we ask the disabled person a question that they would know the answer to and that the facilitator would not. Suddenly the technique no longer works, and this has been the case — without exception — every time it's been formally tried. You'd think this would be a slam-dunk that would put a stop to the practice once and for all; but as regular Skeptoid listeners probably already suspect, the facilitators have an answer for this as well. They move the goalposts. This was explained quite well in a 1993 episode of the TV show Frontline which confronted Douglas Biklen of the Facilitated Communication Institute with this fact. He answered:

I think that test has severe problems. I mean, one, you're putting people in what might be described as a confrontational situation. That is, they're being asked to prove themselves. As I pointed out, confidence appears to be a critical element in the method. If people are anxious, they may, in fact, freeze up in their ability to respond. They may lose confidence. They may feel inadequate.

It's the tired old excuse "Your science is not powerful enough to test our claim." While its proponents may be comfortable adopting this position, they are up against some pretty tall opposition. Practically every major organization in the world involved in communication disabilities has published a position paper discrediting facilitated communication. Here's one from the American Speech-Language-Hearing Association (ASHA), a credentialing association for audiologists, speech pathologists, and speech-language pathology scientists and students, an org dedicated to the improvement of communication for people with communication disabilities:

Facilitated Communication (FC) is a discredited technique that should not be used. There is no scientific evidence of the validity of FC, and there is extensive scientific evidence — produced over several decades and across several countries — that messages are authored by the "facilitator" rather than the person with a disability. Furthermore, there is extensive evidence of harms related to the use of FC. Information obtained through the use of FC should not be considered as the communication of the person with a disability.

From the American Association on Intellectual and Developmental Disabilities (AAIDD):

Based on the current scientific evidence, the Board does not support the use of Facilitated Communication (FC) or the Rapid Prompting Method (RPM) as modes of communication for people with disabilities. In the case of FC, there is no scientific evidence supporting its validity, and there is considerable evidence that the messages are authored by the facilitator rather than by the individual with a disability.

The American Psychological Association (APA) has this to add:

APA adopts the position that facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy.

Here's one from the International Society for Augmentative and Alternative Communication (ISAAC):

ISAAC does not support FC as a valid form of AAC, a valid means for people to access AAC, or a valid means to communicate important life decisions. The weight of evidence does not support FC and therefore it cannot be recommended for use in clinical practice.

That's enough of these for now, but we could literally go on all day if we wanted. The ISAAC statement concludes with "This position statement is consistent with the position statements of the following reputable organizations:" and it then lists fifteen such international bodies. Incidentally, they also point out that facilitated communication is in violation of articles 12, 16, 17, and 21 of the United Nations Conventions on the Rights of Persons with Disabilities.

Aside from moving the goalposts to escape the proof that it doesn't work, advocates for facilitated communication have another tool at their disposal: they come up with new names for the same basic technique. A common one is Supported Typing; others include Informative Pointing, Assisted Typing, Letter Boarding, Intuitive Pointing, Speaking with Eyes, and more. Sometimes they subtly change the way the technique is performed to deceive people into thinking it's some new innovation. One of these is Rapid Prompting Method which has other nicknames of its own: Informative Pointing, Spelling to Communicate, Alphabet Therapy, and so on. Painfully, during Autism Awareness Month in 2016, Apple produced a video showing a non-communicative teen using an iPad to touch icons which then produce synthesized speech — with a facilitator holding the iPad in such a way that she was actually moving it to touch his finger, rather than the other way around — which is how Rapid Prompting Method works. It was exactly the kind of feel-good marketing that keeps facilitated communication in the foreground. The average person doesn't know that it's fake, and seeing such validation as that gives it a positive spin.

The majority of facilitators and advocates probably don't think it's fake either. Most of them believe that the disabled person's communication is real and that they are providing a valuable service. Of course they know that they are themselves moving the person's hand — that's their whole job — and the subtleties of reading signals and small movements from disabled person provide enough feedback to persuade the facilitator that what they're doing is real. A reporter for Slate interviewed some of them in 2015 and found them all to be heavily invested in the reality of their belief system. One former facilitator, Janyce Boynton, has gotten a lot of press for having changed her mind and now speaks out against the practice. For her, the depth of her invested belief was disastrous.

In 1992 Boynton believed she was honestly communicating the thoughts of a 16-year-old autistic girl when she accused the girl's father of having sexually abused her. She and her brother were removed from the home for their own protection, both parents were criminally charged, and the father spent 80 days in jail. Fortunately, the case fell apart when authorities put Boynton to the test — in which she wholeheartedly participated, eager to know the truth herself. The director of the Center for Communication Enhancement and the Autism Language Program at Boston Children's Hospital designed and administered a double-blinded test. They showed pictures of familiar objects individually to both Boynton and the child, and asked the child to type the name of the object — with Boynton facilitating. Only sometimes, they were not both shown the same picture. And, without exception, every time the pictures differed, it was the object shown to Boynton, and not to the child, that was typed. After this and some similar tests were completed, Boynton had scored a 100% failure rate. Not only did it clear the parents of potentially life-destroying sexual assault charges, it convinced Boynton herself that facilitated communication was completely fake.

The episode also offered more insight into how facilitators can come to be duped into believing in their own nonexistent ability. In this particular case, the child had become violent for several days before the surfacing of the assault. Boynton was a properly trained speech therapist, and she and others knew that changes in behavior, particularly acting out violence, often signals problems at home. Boynton had conflated her actual knowledge with the facilitated communication successes she seemed to be having with the girl, and from that perspective, it was only prudent to probe for the cause of the violence. The nonexistent sexual assault was the result. Today Boynton believes the child's violence was her response to the facilitated communication process itself, and having untrue words put into her mouth.

Sadly it was not the only time something like this has happened. The pro-science website FacilitatedCommunication.org details nearly 20 such cases — of the more than 60 known — where a facilitator made up false allegations of rape and abuse that caused someone to be charged with a crime (or almost charged), and in some of these people did end up going to jail before the deception was uncovered.

There is a widely-publicized video produced by the Associated Press in 2015 and available on YouTube reporting on the case of Rom Houben, a Belgian man who received a brain injury in a car accident and has been in a vegetative state ever since. Unfortunately, the reporting is completely credulous, and trumpets the success of his facilitated communication as a great medical miracle. "There are a lot of Roms in the sense that a mistake was made in the diagnosis of a vegetative state," says his doctor in the video.

Rom himself — according to the results of him with his facilitator typing on a tablet — added "Imagine, you hear, see and feel and think but nobody takes any notice. You undergo everything without participating in life." He's shown typing this, his eyes closed or barely open at best, his head hanging unconsciously to the side, his arms limp and lifeless, while the facilitator takes his hand and rapidly types out the sentence on the tablet's onscreen keyboard — not only is the typing fast, it is error-free. The claim being made is that this poor man, who is completely vegetative and unresponsive, is nevertheless giving physical cues to the facilitator for what he wants to type faster than you or I could even speak the letters, and all without being attentive to what's happening on the keyboard. It's quite a sad video as the deception is so blatant, but a bit mystifying that his doctors and the Associated Press reporter were taken in so thoroughly.

But that's the power of hope. We all want it to be true. Sadly, we see yet again that there are no magically easy answers to difficult problems. But we'll never run out of wishes.

By Brian Dunning
Follow @BrianDunning