Inside: Facilitated communication is used with individuals with autism spectrum disorder who have difficulty communicating verbally. There is limited evidence to support the effectiveness of facilitated communication, and there are concerns about the reliability of the method and its potential negative effects.
When you have a disabled child, there is no shortage of people offering you suggestions on how to “fix” your child. Friends, family, strangers…they’re everywhere. And, a lot of the ‘helpful’ advice comes in waves and trends.
Since K is almost an adult, we’ve been doing this long enough to have survived countless suggestions through these trends. These trends often follow media stories, and that’s how the general public hears about them.
Little Charlotte, for whom the strain of marijuana “Charlotte’s Web” is named, was the same age as K (she passed away in 2020). Since her story made national headlines, it felt like every week, someone was suggesting that we look into her story and try what she did for her seizures, to address K’s seizures.
Before that, it was not vaccinating, and then there was the gf/cf diet, which surely would “cure” his autism.
Now, we have a lot of FC or facilitated communication, stories in the news. Once again, I am frequently inundated with suggestions of, “Hey, have you tried…” or “I saw on the news….”
Better still, there was actually a local man featured who supposedly is using this, so it feels like it’s everywhere we go.
Let me be clear–I DO NOT believe in facilitated communication. There is no evidence that it works. And perpetuating practices like this, with no proof that they work, is harmful to the disability community. It is not popular to say this out loud, and I will likely receive emails telling me that I am an oppressor and trying to silence the disabled.
FC Facilitated Communication
Facilitated communication is a communication method that is often used with individuals with autism spectrum disorder (ASD) who have difficulty communicating verbally.
Facilitating communication (FC) was introduced in the 1980s as a new method for helping non-speaking individuals communicate. The basic method is for a facilitator to hold the hand of the non-speaker and help them point to letters on a board or type on a keyboard.
At first, it seemed this was a breakthrough method, allowing many non- or minimally-speaking individuals to reveal their hidden inner voice. By the early 1990s, however, the illusion had burst. More and more studies showed that the facilitator did all the communication, not the client. (Science Based Medicine, 2022)
The method involves a facilitator who supports the individual with ASD as they type or point to letters on a keyboard or other communication device. The facilitator is meant to provide physical or emotional support to the individual with ASD, but there is controversy surrounding the effectiveness of this method.
I mean it when I say, “Think about a Ouija board.” Because that’s essentially what it is.
Despite its widespread use, limited evidence supports the effectiveness of facilitated communication. Some studies have suggested that the method may not be reliable and that the facilitator may unconsciously influence the communication.
What is Facilitated Communication?
Facilitated Communication (FC) is a controversial method of alternative and augmentative communication (AAC) that aims to assist individuals with limited speech or communication abilities, including those with autism. In FC, a facilitator physically supports the disabled individual while they type or point to letters, words, or pictures on a communication device, such as a keyboard or a tablet.
It’s for non-verbal or non-speaking people, including many autistic people. But intellectually disabled people are exploited in this charade too.
The facilitator’s role is to provide the individual with the necessary physical support and guidance to help them communicate their thoughts and feelings effectively.
The use of FC has been debated in the autism community for several decades. Proponents of FC argue that it can help individuals with autism who are nonverbal or have limited verbal abilities to express themselves and communicate with others.
They claim that FC has helped many individuals with autism develop language and communication skills that they otherwise would not have been able to acquire.
However, critics of FC argue that it is not a valid method of communication and that the facilitator, rather than the individual with autism, controls the communication. They claim that FC relies on subtle cues and prompts from the facilitator rather than the individual’s own thoughts and intentions.
S2C Spelling to Communicate
Although this concept is only 40 years old, it has undergone several “revisions” and name changes. You may have seen “S2C” or Spelling to Communicate. RPM is another version. RPM stands for Rapid Prompting Method. These are all the same thing.
Critics also point out that there is a lack of scientific evidence to support the effectiveness of FC, and that the few studies conducted on FC have found it ineffective.
Despite the controversy surrounding FC, some individuals with autism and their families continue to use it as a form of communication.
S2C on TV
Many people have told me, “But I saw it on TV!” And yes, lately, it has been on TV often.
However, that doesn’t prove that it works. The media loves a feel-good story, and they love exploiting disabled people. Of course you see it on TV!
It’s also inherently ableist—the need to “fix” folks who cannot talk.
FC and S2C People Seem Happy
When you see disabled people on TV, seemingly communicating after many years of not being able to, you can’t help but cheer for them.
But take a deeper look. Yes, they seem happy. But are they happy because they finally found S2C? Or are they happy because they are receiving a lot of attention? Attention that they previously did not receive?
I’m going to go with the latter. Any person who has largely been ignored by family and loved ones because they could not figure out a way to communicate and now suddenly is showered with positive attention–it will be a positive experience for them.
That’s what makes this exceptionally sad and exploitative.
The Theory Behind Facilitated Communication
Facilitated Communication (FC) is a technique used to help nonverbal individuals communicate by providing physical support to their hands or arms while they type or point to letters, symbols, or pictures on a keyboard or communication board.
The technique is based on the principle that nonverbal individuals with autism and other communication disorders have the ability to communicate, but they lack the motor skills or coordination to do so independently.
By providing physical support, facilitators can help autistic individuals express themselves and communicate their thoughts, feelings, and needs.
Principles of Facilitated Communication
The principles of FC are based on the idea that nonverbal individuals with autism have the ability to communicate, but they lack the motor skills or coordination to do so independently. Facilitators provide physical support to help individuals with autism type or point to letters, symbols, or pictures on a keyboard or communication board.
The facilitator is not supposed to guide the individual’s hand or arm but rather provide enough support to help them complete the motor task. Study after study has shown that the facilitator is the one who chooses the letters and the words. Not the disabled person.
The intended outcomes of FC are to help nonverbal individuals with autism communicate their thoughts, feelings, and needs. The technique is supposed to help autistic individuals become more independent and improve their communication skills.
FC aims to help autistic individuals express themselves and participate more fully in their daily lives.
However, there is a lot of controversy surrounding the effectiveness of FC, and research has shown that the technique is not reliable or valid. Critics argue that the facilitators, rather than the individuals with autism, are controlling the communication and that FC does not improve language skills.
Evidence on Effectiveness
Facilitated communication (FC) is a controversial method of communication for individuals with autism spectrum disorder (ASD). According to the Association for Science in Autism Treatment (ASAT), FC involves a facilitator who supports the arm or hand of a person with ASD to help them type out their thoughts on a keyboard or other device.
However, research evidence, replicated across several hundred children with ASD, shows that the facilitators, rather than the individuals with ASD, control the communication and that FC does not improve language skills (ASAT).
A study published in the Journal of Autism and Developmental Disorders found that FC was not a reliable method of communication for individuals with ASD. The study analyzed 20 cases where FC was used, and the results showed that the facilitators were responsible for the messages that were produced, not the individuals with ASD.
The study concluded that FC is not a scientifically valid method of communication for individuals with ASD (Journal of Autism and Developmental Disorders).
Despite the lack of scientific evidence supporting the effectiveness of FC, some case studies have shown positive results. For example, a case study published in the Journal of Developmental and Physical Disabilities reported that FC helped a 21-year-old woman with ASD to communicate with her family and caregivers.
The study found that the woman could communicate her needs and preferences using FC, and her quality of life improved as a result (Journal of Developmental and Physical Disabilities).
Another case study published in the Journal of Autism and Developmental Disorders reported that FC helped a 10-year-old boy with ASD to communicate with his family and teachers. The study found that the boy could express his thoughts and feelings using FC, and his communication skills improved as a result (Journal of Autism and Developmental Disorders).
Case studies are anecdotes. Anecdotes are not data.
There has not been any study, of any meaningful sample size, that demonstrates the effectiveness of FC.
Facilitated Communication is Controversial
Facilitated communication (FC) has been a controversial and heavily criticized approach to communication with non-verbal people diagnosed with autism spectrum disorder (ASD).
While some proponents of FC believe it is a way to allow individuals with ASD to communicate, others argue that it is a pseudoscientific practice that has been debunked by scientific scrutiny.
There are some people who (apparently) enjoy being the faces of FC and are often in the media. These folks have never agreed to participate in a non-biased study. In other words, they have never demonstrated “proof” of what they are doing. They control the message in the media.
Parents are Vulnerable
Parents like us can be extremely vulnerable. We face obstacles everywhere we go–school, community, health care, and insurance companies. It’s exhausting–and I speak from experience.
When a parent sees a solution, of course, they will go for it! And you might think, “Well why not? It’s not hurting anyone?!”
Or is it?
FC is Ableist AF
If FC or S2C worked, that’d be great. But it doesn’t. After 40 years, if it worked, we’d have the data; we don’t.
Using something like this when it doesn’t work, is ableist.
It’s that syndrome of “chasing the intact mind.” That belief that my son (and others like him) are not good enough the way they are. There must be an intact brain somewhere, if only we knew how to liberate it.
Right? We all have our own little Stephen Hawking at home if only we knew how to reach him.
That’s not who my son is. He is severely autistic and intellectually disabled and cannot talk. To continue to use a Ouija board and claim it’s his communication is nothing short of ableist at this point.
FC Harms Disabled People
There are so many ways that facilitated communication harms disabled people, aside from being ableist. I’ll be brief.
- It removes resources from finding communication methods that work for the disabled person.
- Suppresses the disabled person’s voice and, at the same time, tells them they have a voice.
- The risk for disabled people in “saying” things they never actually said or thought; can be particularly dangerous when it comes to money, abuse, and other disputes.
- Supports ableist beliefs that a person only has value when they can communicate using traditional methods.
Numerous studies have found that FC is not a reliable method of communication for people with ASD. For example, a study published in the Journal of Autism and Developmental Disorders found that FC was no more effective than chance at producing accurate messages from people with autism.
Some criticisms can be made after observing a few demonstrations of FC in action. For starters, in a few instances, the disabled individual isn’t even looking at the letter board or keyboard, which may continue for most of the time in which they are supposedly communicating. Secondly, in other demonstrations, it appears the facilitator assisting the communicator does quite a bit of assisting.
So much so, that, at times, it looks as if the facilitator is doing more than just guiding the hand or arm and is actually just using the communicator’s hand to type.
The most damning evidence, however, comes in the form of a series of experiments conducted to test just who is doing the communicating. One in particular, done by Smith, Haas, and Belcher (1994), consisted of presenting either matching or differing pictures, objects, or messages to the facilitator and communicator.
Communicators were told to describe what they had seen using varying levels of FC (no help, hand-over-hand support with error prevention, and hand-over-hand support without error prevention). Correct answers were obtained only when the facilitator and communicator saw the same image, and a full support style of FC was used.
After 40 years, if this worked, we’d have data.
In addition to the scientific criticisms of FC, ethical concerns surround the practice. One major concern is that FC can lead to false accusations of abuse. For example, a person with autism who uses FC might accuse a caregiver of abuse, but it is unclear whether the accusation is coming from the person with autism or the facilitator. This can lead to legal and emotional consequences for the accused, as well as potential harm to the person with autism if the accusation is unfounded.
Another ethical concern is that FC can be used to promote dangerous or harmful practices. For example, a facilitator might encourage a person with autism to stop taking medication or engage in risky behaviors, based on the facilitator’s own beliefs or biases.
Alternative Communication Methods
Individuals with autism may experience difficulty communicating verbally, which can lead to frustration and isolation. Fortunately, there are alternative communication methods that can help individuals with autism express themselves and communicate with others.
Augmentative and Alternative Communication
Augmentative and alternative communication (AAC) is an umbrella term that refers to communication methods that supplement or replace speech for individuals who cannot use speech to meet their communication needs. AAC systems may be unaided or aided.
Unaided AAC does not require special tools, while aided AAC requires some form of external support. Some examples of AAC include sign language, picture communication boards, and speech-generating devices.
Speech-generating devices (SGDs) are electronic devices that allow individuals with communication difficulties to express themselves through synthesized speech. SGDs use various input methods, such as touchscreens, eye-tracking, or switches, to generate speech output.
SGDs can be customized to meet the individual’s specific communication needs and can be programmed with pre-set phrases or words.
SGDs have been shown to be an effective form of AAC for individuals with autism. They can help individuals with autism communicate their thoughts and feelings, participate in social interactions, and improve their overall quality of life.
However, SGDs can be expensive and may not be covered by insurance, which can limit access for some.
Legal and Policy Implications
Facilitated Communication (FC) has been a controversial topic with legal and policy implications. While some individuals and organizations support the use of FC as a way for people with autism to communicate, others have raised concerns about its effectiveness and accuracy.
In the United States, the use of FC has been the subject of legal cases involving allegations of abuse and neglect. Some courts have allowed evidence obtained through FC to be used in legal proceedings, while others have excluded it as unreliable.
For example, in the case of J.L. v. Mercer Island School District, a federal court ruled that evidence obtained through FC was not reliable and could not be used to support a student’s claims of abuse and neglect.
S2C Policy Implications
Early proponents of FC and S2C are now some of its most vocal critics. Additionally,
There are a couple of organizations who support FC. The biggest and probably best known one is ASAN–Autistic Self Advocacy Network.
And, ASAN supporters argue that none of the opposing organizations are run/populated by autistic people, thus leading to oppression of autistic people.
I have mixed feelings about ASAN because they fail to (IMO) support severely autistic people enough. If you can find and join an autistic network of people online, then your functioning level is quite different from my son’s. He deserves a voice too.
Some of the groups that publicly oppose FC are:
- The American Academy of Child and Adolescent Psychiatry (AACAP)
- The American Academy of Pediatrics (AAP)
- The American Association on Intellectual and Developmental Disabilities (AAIDD), previously called the American Association on Mental Retardation (AAMR)
The Board of Directors concludes that rather than helping people express their thoughts, desires, and choices, FC and RPM have the potential to effectively take away people’s voices. This is due to the risk of facilitator influence/authorship as well as the potential to displace efforts to access scientifically valid communication modes, such as those associated with the field of Augmentative and Alternative Communication (AAC).
It is the position of the American Speech-Language-Hearing Association (ASHA) that use of the Rapid Prompting Method (RPM) is not recommended because of prompt dependency and the lack of scientific validity. Furthermore, information obtained through the use of RPM should not be assumed to be the communication of the person with a disability.
While the lack of evidence from previously conducted studies does not necessarily indicate that RPM is not effective at developing communication skills and reducing stereotypic behaviors in learners with autism, use of this intervention should not be used or recommended by practitioners until the claims made can be substantiated by peer reviewed research studies.
- The Federal Trade Commission (FTC)
- Heilpädagogische Forschung
- The Institute on Disability (IOD) at the University of New Hampshire
- The University of Northern Iowa
- The International Society for Augmentative and Alternative Communication (ISAAC)
…given ISAAC’s mission to promote the best possible communication abilities and opportunities for persons with limited or no functional speech, 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.
Future research should continue to explore the underlying mechanisms of communication difficulties in individuals with autism. This includes investigating the neural and cognitive processes contributing to communication impairments and identifying individual differences in communication abilities and needs.
While FC remains a controversial and unsupported technique, promising alternatives are effective in improving communication skills in individuals with autism.
Future research should explore these alternatives and investigate the underlying mechanisms of communication difficulties in individuals with autism.
Frequently Asked Questions
What is the effectiveness of facilitated communication in treating autism?
Facilitated Communication (FC) is a controversial technique that involves a facilitator providing physical support to the individual with autism while they attempt to communicate using a communication device. According to the Association for Science in Autism Treatment, research evidence shows that FC does not improve language skills, and the facilitators rather than the individuals with autism spectrum disorders control the communication . Therefore, FC is not considered an effective intervention for treating autism.
How does facilitated communication compare to other AAC methods for individuals with autism?
Augmentative and Alternative Communication (AAC) methods are a range of techniques and tools that can help individuals with autism who have difficulty with verbal communication. Compared to other AAC methods such as Picture Exchange Communication System (PECS) and speech-generating devices, FC lacks empirical support and is not recommended as an effective intervention for autistic individuals .
What stance does the American Speech-Language-Hearing Association (ASHA) take on facilitated communication?
The American Speech-Language-Hearing Association (ASHA) does not support the use of FC for individuals with autism and other disabilities. ASHA states that there is no scientific evidence to support the effectiveness of FC, and that it is important to use evidence-based practices to ensure the best outcomes for individuals with communication disorders .
What are the advantages of using facilitated communication with autistic individuals?
There are no proven advantages to using FC for autistic individuals. In fact, there are several risks associated with the use of FC, including the facilitator’s influence on the communication, the potential for the facilitator to unintentionally or intentionally communicate their own thoughts or beliefs, and the possibility of false allegations of abuse .
What training is required for professionals to implement facilitated communication effectively?
There is no standardized training or certification process for FC facilitators, which raises concerns about the reliability and validity of the technique. Professionals who work with individuals with autism are encouraged to use evidence-based practices and to seek training in AAC methods that have been scientifically validated, such as PECS and speech-generating devices .
Has facilitated communication been scientifically validated or refuted for autism intervention?
Several studies have shown that FC lacks empirical support and is not an effective intervention for individuals with autism . Furthermore, many professional organizations, including ASHA, do not support the use of FC due to the lack of scientific evidence supporting its effectiveness . Therefore, FC should not be considered a scientifically validated intervention for autism.
 Association for Science in Autism Treatment. (n.d.). Facilitated Communication. Retrieved from https://asatonline.org/for-parents/learn-more-about-specific-treatments/facilitated-communication/
 National Autism Center. (2015). Findings and Conclusions: National Standards Project, Phase 2. Randolph, MA: National Autism Center.
 American Speech-Language-Hearing Association. (n.d.). Facilitated Communication. Retrieved from https://www.asha.org/Practice-Portal/Professional-Issues/Facilitated-Communication/