Confidence and Facilitated Communication
by Alan Kurtz
As with many people with autism my friend Jay sometimes gets stuck. He has difficulty moving from one activity to another. Sometimes Jay needs someone to touch his hand before he can proceed through an automatic door at the supermarket. At other times Jay gets his finger "stuck" on an object such as a grocery cart, a drain, or a sign post. When this happens Jay needs someone to touch his hand so that he can move away. Of course Jay is not actually physically stuck. Usually a light touch on the arm or hand is enough to free Jay from these objects. At other times just getting close to him is sufficient. Sometimes when Jay is stuck anyone can help but at other times only the touch of certain people will do.
Last November while walking down a street in New Orleans Jay got stuck on a sign post. Debbie Gilmer noticed it first and backed up a few steps. She touched his arm just as I normally do and as she had done many times in the past. Jay would not budge. He pointed at me. I walked over to him, touched his arm, and we continued on our walk.
This experience is similar to the experiences of new facilitators. Often a new facilitator may need to provide more physical support than a more familiar one. Sometimes, even with additional support, the FC speaker is unable to type with the same skill that s/he normally can.
Jane was typing with a new job coach. A person who had been facilitating Jane for nearly a year stood by and made suggestions to both Jane and her new facilitator. Jane had been typing with support at the elbow with two familiar facilitators but her job coach needed to provide support at the wrist. Even with this level of support Jane struggled. After typing "I want to ride" she stopped. Jane seemed almost to be having physical difficulty moving her hand forward. Jane's hand repeatedly moved an inch or so toward the keyboard but each time she jerked it back. Jane was becoming very frustrated. It was time for her to go but she refused to put on her coat. Finally the experienced facilitator touched her elbow. With her job coach continuing to support her wrist, Jane finished her sentence: "...on your snow machine."
In both of these examples neither Jay nor Jane seemed physically capable of continuing their movement. In both cases they were attempting things that they had at times done either with much less support or independently. Both required the touch of someone in whom they had confidence. Neither Jane's facilitator nor Debbie did anything wrong. They performed the procedures correctly - the same way others had successfully performed them. At the same time there was nothing magical about the way Jane's familiar facilitator touched her elbow allowing her to finish the sentence.
We have known since Biklen (1990) published his first article on facilitated communication that FC users sometimes do better with certain facilitators than others. We have often seen FC users type with very little support with one facilitator while requiring full physical support with someone new. FC users provided many reasons for these differences but a common theme is that particular facilitators give them confidence.
Crossley lists thirteen problems interfering with independent pointing (Crossley, 1994). Problem 13 is "lack of confidence." At first this seems incongruous with the other problems on her list because the first twelve are physical problems such as "low muscle tone" and "proximal instability." "Lack of confidence" seems to be more "psychological." Crossley (1994) justifies its inclusion by saying, "While not itself a physical problem nervousness certainly affects physical performance" (p.25).
Interestingly, occupational therapists regard confidence and praxis as inextricably linked. Like Crossley, they see confidence as an important component of physical performance. When occupational therapists work on sensory integration they often choose motor activities that will help the child build confidence and self esteem. They try things that will challenge the child but will not be too difficult for him/her to succeed. (Fisher & Murray, 1991; Kielhofner & Fisher, 1991).
Lack of confidence can be a self fulfilling prophecy. Downhill skiers know that they have more control when they lean forward and face downhill. Unfortunately most novice skiers lack the confidence to do these things at critical moments. Instead they might react to increasing speed by leaning backwards which can cause them to fall. When a skier reacts by turning his/her body sideways s/he has less control in turning. Learning to ski is like learning many other complex motor activities. Confidence and performance develop together.
If we view communication through typing as a new motor skill, it makes sense that instilling confidence would be an important aspect of FC. Facilitated communication may help a person's confidence in several ways:
· Facilitators structure activities to ensure success and minimize opportunities to fail. · Facilitators remain positive and maintain high expectations. · The presence of familiar facilitators may let the FC users know that someone will be there when they need support. · Sensory feedback from the facilitator's touch may it easier for FC users to move their hands in the way they intend. · Facilitators may interrupt certain behaviors that may interfere with successful communication. These include perseveration, typing echoes, or impulsivity.
Structuring success. As most trained facilitators know, we usually start with simple, highly structured activities and move to more complex and open-ended ones. Crossley (1994) refers to this as "structuring success". We do this to help the person build confidence in his/her ability to communicate.
Positive support and high expectations. We know that everyone performs better when people around them have high expectations. By remaining positive and encouraging both performance and confidence should improve.
Presence of familiar facilitator. Jay does not always physically need someone to help him when he is "stuck." Jane can sometimes type independently. They both do better, however, when someone is there who they know they can count on when they do need help. It may be for this reason that individuals like Sharisa Kochmeister can type independently but only when a familiar facilitator sits next to them.
Sensory feedback. For many years we have known that people with autism have proprioceptive (sense of where one's body is in space) and vestibular (balance) problems (Damasio & Maurer, 1978). When a person has difficulty integrating this sensory information as well as tactile information, motor planning or praxis may be affected. The physical touch may provide the FC user with important feedback that makes motor planning less difficult. When the person begins to be successful, s/he gains confidence and is more likely to attempt more challenging things.
Interrupting behaviors that may interfere with communication. Sometimes inexperienced or untrained facilitators allow an FC user to type perseveratively or to type random letters. As a result the FC user may lose confidence in both his/her own ability and the ability of the facilitator. I recently worked with a speech therapist who had little training in FC. She worked with a boy who did well with other facilitators but not with her. Through his behavior the boy demonstrated that he did not like facilitating with her although he did like doing other things with her. After I demonstrated the importance of providing firm backwards resistance with this particular student she tried again. This time they both were successful and they both gained a great deal of confidence. The student's broad smile demonstrated very clearly that he was enjoying his facilitator's new approach. The previous example demonstrates the importance of confidence for both communication partners. The FC user needs to know that the facilitator will be there to provide whatever support is necessary for him/her to succeed. The facilitator must have the confidence necessary to maintain high expectations and to try new approaches when things are not going well. When a facilitator uses good technique and the partners are successful, they both gain the confidence to continue on to bigger and better things.
Confidence is not, strictly speaking, a motor problem. A lack of confidence, however, appears to make trying new or challenging activities more difficult. For people who have had little success communicating throughout their life, helping them build confidence may be essential.
References Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review, 60(3), pp.242-256. Crossley, R. (1994). Facilitated communication training. New York: Teachers College Press. Fisher, A.G., & Murray, E.A. (1991). Introduction to sensory integration theory. In A.G. Fisher, E.A. Murray, & A.C. Bundy (Eds.), Sensory integration: Theory and practice (pp. 27-45), Philadelphia: F.A. Davis Company. Kielhofner, G. & Fisher, A.G. (1991). Mind-brain-body relationships. In A.G. Fisher, E.A. Murray, & A.C. Bundy (Eds.), Sensory integration: Theory and practice (pp. 27-45), Philadelphia: F.A. Davis Company.
The purpose of Facilitated Communication In Maine is to promote the appropriate use of facilitated communication through education, technical assistance, and support to people with disabilities, parents, educators, speech and language pathologists support providers, and other interested individuals. The project provides up-to-date information on current best practices, introductory and advanced workshops on the technique, resources regarding theoretical and practical components of facilitated communication and ongoing support to a network of resource persons who provide local education and support to other facilitators.
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