WHAT IS FACILITATED COMMUNICATION
TRAINING?
by Alan Kurtz
Facilitated Communication Training
Facilitated communication training (FCT) is a technique developed by Rosemary Crossley in Melboume, Australia to help persons with severe communication impairments. Crossley (1993) defines FCT as:
a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In FCT a communication partner (facilitator) helps the communication aid user overcome neuro-motor problems and develop functional movement patterns. The immediate aim in FCT is to allow the aid user to make choices and to communicate in a way that has been impossible previously.
Physical support is provided at the hand or arm, helping the individual to initiate pointing or to point accurately. Over time the support is faded back. Many individuals now communicate withjust ahand on their shoulder or even independently.
Douglas Biklen of Syracuse University introduced the technique to the United States. Biklen and his graduate students began using FCT in the public schools in the Syracuse in 1990, where it was tried primarily with students with autism. Biklen discovered that most of the children with whom they tried FCT had preexisting, usually previously unidentified, literacy skills. This was consistent with the results Crossley had obtained in Australia where many individuals with labels of profound or severe mental retardation had been able to type words with facilitation.
To most untrained observers, FCT appears deceptively simple. The facihtator merely places his/her hand under the user's hand or arm. The person then begins to type. In fact, FCT is very complex.
FCT consists of two major components (Kurtz & Ashe, 1993): "(1) the physical correction and support facilitators use in helping individuals overcome specific neuro-motorproblems, and (2) an approach which the facilitator demonstrates high expectations and a positive supportive attitude toward the speaker [the FC user]." Both these components, and the confidence they engender, are essential for success.
Biklen (1990) and Crossley (1988) believe that individuals have failed to type independently in the past because of motor planning problems. The neurological problems that make speech difficult may also make it difficult to initiate and carry out many other motor activities, including pointing to letters to spell words. Biklen, Morton, Gold & Swaminathan (1992) believe that persons with autism may be suffering from global dyspraxia - an inability to adequately control voluntary physical activity. The existence of dyspraxia and other movement disorders in individuals with autism has been documented (Hill &Leary, 1993; Damasio & Maurer 1978).
Dyspraxia must be distinguished from poor motor control. Dyspraxia can affect a person's ability to initiate and sequence new motor tasks. Each time a person initiates speech or independent typing s/he is faced with the task of producing a new motor sequence. Each sentence that s/he constructs may require a new sequence of motor responses that a speaker has never previously put together. Kimball (1992) points out that a child with dyspraxia may have trouble thinking and engaging in a fine motor task at the same time. A child who can print his or her name may have difficulty printing when trying to express ideas.
Crossley (1992) identified thirteen problems (primarily neuro-motor) interfering with independent pointing. They are poor eye-hand coordination, low muscle tone, high muscle tone, index finger isolation and extension problems, perseveration, using both hands for a task only requiring one, tremor, radial/ulnar muscle instability, initiation problems, impulsivity, proximal instability, reduced proprioception, and a lack of confidence, Physical support is required to accommodate some of these problems.
For example, a common problem seen in the typing of people with autism is perseveration. An individual might hit the same letter repeatedly or they might begin typing the alphabet. On a computer keyboard or typewriter, I have seen individuals begin to type 'QWERTY" or "ASDFG." Sometimes an individual will have favorite letters they type automatically when their level of anxiety is high. One woman who I worked with tried to type "N" whenever she became anxious or distracted. To correct for perseveration, we simply pull the person back and encourage them to go on. We might say, "Wnat's next" or "Wnat comes after the 'A' in that word?" If necessary we might tell them what the next letter is or point to it with our free hand.
In correcting any of the thirteen problems listed by Crossley, the facilitator helps the speaker "not to make mistakes" (Biklen, 1993). The speaker is pulled back from the motor planning errors and prompted to continue. Facilitators never guide someone to the correct choice. The speaker should always initiate the movement toward the target. Backward pressure only should be provided to slow a person down or prevent him/her from making mistakes.
In addition to providing physical support, the facilitator must
provide emotional support. The facilitator conveys his/her
expectation that his/her communication partner is intelligent and
will succeed. Facilitators talk to the FC speaker using the same
language they would with anyone else his/her age. Good facilitators
remain positive avoiding terms such as "Wrong...... Incorrect," or
"No." Through his/her actions, speech, body language, the facilitator
conveys a belief in the speaker's competence. The facilitator also
conveys his/her belief in the speaker's intelligence by offering
him/her choices and by selecting appropriate learning materials.
Who is a candidate for FCT?
Crossley (I 993) says that FCT "is a teaching strategy of particular relevance to individuals with severe communication impairments (SCI) who do not have severe physical impairments but nonetheless have had difficulty acquiring handwriting and manual signing skills." FCT has also been helpful with persons with good hand writing skills or independent typing skills but whose writing is characterized by stereotypical communication. Many who have been successful with FCT had previously been labeled severely or profoundly retarded.
Preexisting literacy skills are not necessary for participation in FTC. While many FCT users have unanticipated literacy skills, many individuals need extensive training. According to Crossley (1993), one of the most prevalent myths about FCT is that all FCT speakers have mysteriously acquired literacy skills. Through repeated incidental exposure many individuals have developed the ability to read and spell some words. Others may not have this ability or it may be very limited. FCT may be useful in teaching some of those individuals to read and spell.
I have worked with individuals demonstrating a wide range of literacy skills with facilitation. Those who have spent time in print rich environments, attended regular integrated classrooms, whose parents read to them, or who had received reading instruction were more likely to begin FCT at a higher skill level. Adults who had spent much of their life in institutions were much less likely to have advanced literacy skills. Most of the people with whom I have worked have required some training in grammar, word recognition, spelling, spacing, punctuation, and sentence construction.
FCT is not for everyone and not everyone will be able to spell.
Not everyone needs physical support to access a communication device.
It has not made other forms of augmentative and alternative
communication (AAC) obsolete. Crossley (1993) says, "Facilitation is
merely a technique for developing communication aid access skills."
In some cases, physical support may help individuals without spelling
skills to access other forms of AAC.
Is it real?
Because the speaker is dependent on the facilitator for physical support, many people remain skeptical about the source of the communication. Contrary to reports by some critics of FCT (See for example Newhoff, 1993), a number of FC speakers have progressed to the point where they are doing some independent typing. I have personally worked with three individuals who have moved from support of their hands to typing sentences independently. In two cases it took more than two years for the speakers to reach that level. One individual who I know in Vermont had a label of profound mental retardation and no history of any literacy skills. He is now typing single words without physical support.
I have also observed individuals who have moved from full physical support to a touch on the shoulder in a single session. One of them, a teenage girl, had already been typing independently with two hands. Her rapid typing reflected her speech - consisting mostly of commercials and television or movie dialogues. In her first session, with support at her shoulder, she was able to describe her previous typing as "fantasy." She indicated that she wanted to continue facilitation because it helped her not to type fantasy.
FCT speakers often reveal information that the facilitator has no way of knowing. One little boy in
Maine types things he has read at school with incredible recall when his mother facilitates him at home. There are many other examples too numerous to begin to list here.
Unfortunately the critics are not completely wrong. I know of situations in which a facilitator obviously guided a speaker to some or all of the words. Many facilitators have incomplete information about FCT or they have not received the supervision they need to facilitate well. As a result the people they facilitate either fail to achieve at their full potential or they produce words that are not their own.
All people who can benefit from FC deserve the opportunity to
communicate validly at the most sophisticated level possible. It is
hopeful that this article will help clarify what FCT is and what it
is not.
References
Biklen, D.(1990) Communication unbound: Autism and praxis. Harvard Educational Review. 60,291-314.
Biklen, D. (1993) Communication unbound: How facilitated communication is challenging traditional views of autism and ability/disability New York: Teachers College Press
Biklen, D., Morton, M. Gold, D., Berrigan, C.& Swaminathan, S. (I 992). "I AMN NOT A USTIC OH THJE TYP" (I'm not autistic on the typewriter.) Topics in Language Disorders, 12(4), 1-28.
Crossley.R. (October, 1988). Unexpected communication attainments by persons diagnosed as autistic and intellectually impaired. Unpublished paper presented at the meeting of the International Society for Augmentive and Alternative Communication. Los Angeles, CA
Crossley, R. (1993) Facilitated communication training in North America: an Australian perspective. IEEIR Interchange. April,- Special Issue, I- II.
Damasio, and Maurer, R. (1978). A neurological model for childhood autism. Archives of Neurology, 35, 777-786.
Hill,D.A.,& Leary M.R.(1993).Movement disturbance: A clue to hidden competencies in persons diagnosed with autism and other developmental disabilities. "Movin' on"beyond facilitated communication Madison, WI DRI Press
Kimball, J.G. (1992). What is praxis? Unpublished manuscript.
Kurtz, A. & Ashe, W. (I 993) In search of a technology. New England Newsletter on Facilitated Communication. 2(l).
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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