A FRESH LOOK AT VALIDATION
by Alan Kurtz
The fourth annual conference on facilitated communication differed significantly from the first three. On the one hand, participants seemed more critical than they had in the first two conferences. On the other hand, the conference lacked the sense of melancholy that characterized the conference last year. Indeed, many FC supporters, who in 1994 seemed tired and worn by constant battles and debate, were now smiling and excited. The conference seemed solid, grounded, optimistic and upbeat.
Those who have followed the validity debate might wonder why a group of FC supporters could possibly be so thrilled. After all, Frontline, 60 Minutes, NBC's Now, and (my favorite) 20/20 informed us that the debate was over. The research, according to critics demonstrated unequivocally that FC was at best invalid and at worst an intentional hoax.
New controlled studies paint a very different picture.' These experiments, which were designed with sensitivity for both the integrity of the technique and for the unique characteristics of the individual FC users, have produced results that contrast dramatically with early experimental studies. Lessons learned in this research also cast serious doubt upon the validity of the many of the original tests.
WHY FC SUPPORTERS ARE SMILING
Dr. Donald Cardinal and his colleagues at Chapman University have completed the largest experiment to date on the validity of facilitated communication -with more trials than all previous studies combined. They took over a year to develop their experimental protocol carefully studying the conditions that made message passing with a blind-facilitator possible. In developing their protocol they discovered that the most important condition is practice with the specific protocol used in the test. They also found that conducting the test in a person's natural environment is also very important.
Cardinal (1995) conducted a study over six weeks with three sessions a week and five trials in each session. Forty-three students participated. In each trial the student was presented a word selected randomly from a list of 100. The facilitators did not know what the words were in advance of the experiment. In each trial, the facilitator, who was absent when the word was presented, returned and asked the student to type the word. Answers were scored "correct" only if they were spelled perfectly with no extra letters. By the end of the study, 52 percent were able to pass a message at least two of five times in a session. Thirty-two percent were able to pass a message at least four of five times. There was a statistically significant difference between the performance of all students when facilitated and their performance in the unfacilitated baseline conditions p.0001). Clearly, the results cannot be explained by chance or, as some have suggested, "by facilitator guessing."
Cardinal's data also reveal that performance varied greatly from day to day, people generally got better with practice and most significantly no student did any better on the First day of testing than s/he had done in baseline. I emphasize this because if Cardinal had stopped the experiment the first day he would have been unable to demonstrate the positive effect of FC on message passing for any of the 43 students. In fact, most previous researchers have stopped after one day of testing and concluded, perhaps incorrectly, that their subjects could not validly author messages with FC.
Janice Ramsden (1994) , under the direction of Dr. Robert Homer, recently completed her Ph.D. dissertation research in the area of validity of facilitated communication. In her dissertation, she describes four separate studies involving school aged children with severe intellectual disabilities." The studies were conducted in school settings during instruction. Each of the students were determined to be the author of his/her facilitated communication. She also found that teaching the testing procedure tended to improve the person's validation responses. Two of the four students were unable to validate their communication prior to being taught the testing procedure. Ramsden found, just as Cardinal had, that it is important to practice the specific testing procedure prior to a test. Ramsden adapted the experimental protocol for the needs of individual students. Adaptation included providing postural support, cues to initiate or complete movement, and cues to focus. Individualizing the procedure undoubtedly contributed to the students' success. Ramsden concluded: "The findings argue strongly for continued use of facilitated communication for nonverbal people with disabilities."
Carol Vasquez (1994) published a study validating the communication of a boy and a girl using facilitated communication. Both students failed to identify pictures in a blind test. Vasquez then asked them to describe a video to a blind facilitator. The boy succeeded. The girl did not. In a third experiment, in which the girl alone participated, objects were presented. She identified 9 of 10 objects. Vasquez recognized that failure in a single experiment did not mean that the boy and girl's FC was necessarily invalid. She did something almost totally absent from the experiments purporting to demonstrate that FC was invalid. She changed her experimental protocol.
Michael Weiss (1995), a pediatric psychologist from the Boston area, was originally a skeptic, publicly referring to FC as a "bloody hoax." he gradually began to reconsider his position however after working with a ten year old boy with autism. Weiss tried validating the boy's communication using tests similar to the ones described in journals. In each es the boy failed to validate. Ultimately Dr. Weiss devised a test in which an independent observer wrote a story and gave it to him. He shared it with the boy. When the boy's normal facilitator, who had never heard the story, returned, the boy was asked questions about the story. The boy answered them correctly with very exact and detailed information. The boy has repeatedly demonstrated the validity of his communication in this way. Weiss has since validated the communication of another child with the same experiment. Like Vasquez, Michael Weiss recognized that failure with a specific protocol did not mean that a person's communication was invalid. Like Cardinal, he understood that failure to demonstrate a phenomenon on a single day in a single experiment does not prove that the phenomenon does not exist.
Marj Olney, in her Ph.D. dissertation at Syracuse University, demonstrated that FC users could learn to answer questions correctly in Computer games requiring literacy. The facilitators were unable to see the screen. Olney gave the individuals many opportunities to practice the protocol before testing them. She also asked their permission before attempting blind trials.
Simon, Toll, and Whitehair (1994) demonstrated that 4 of 7 students were the authors of some of their communication. They also demonstrated facilitator influence. The authors explain their success, which stands in contrast to most earlier published studies, by pointing to the naturalistic unobtrusive setting in which the experiment took place. Each student participated in only 15 trials over eight days. (Based on other research, one would expect scores to improve if they continued testing over a longer period of time.)
Independence. In addition to the controlled studies, a number of FC users have become independent or they have learned to type with only intermittent physical support. The most dramatic example of independence is Sharisa Kochmeister. Evaluated as having an IQ of 10, Sharisa has no speech, and prior to FC, had demonstrated no literacy skills. After several years of FC, Sharisa now types completely independently with her father sifting behind her. Through her typing, Sharisa expresses complex thoughts and ideas.
PROBLEMS WITH EARLY CONTROLLED STUDIES
Like the debate on FC itself, the research seems completely polarized. Some studies seem to indicate that facilitated communication works. Others conclude that no users can author their own communication. The discrepancy can be explained in part by some of the following problems in the early research:
FC AT A CROSSROADS
The criticism of FC has not always been fair but it has not been completely unjustified. Many people do facilitated communication poorly. Clearly the words of many FC users are not always their own. The criticism of FC has forced practitioners to be more conscious of their ability to guide or cue letters and words. Partly as a result of criticism, proponents of FC and researchers are asking important questions such as "What makes a good facilitator?", "What is good FC?" "How do we ensure that facilitators are properly trained?", and "How can we be sure that typed words are the users and not the facilitators?"
I believe that FC is at a crucial juncture. e technique is gaining a new respectability that will only be enhanced with more research. We have learned a great-deal in the last four years about the training and support people need to be successful facilitators If people receive effective instruction and ongoing supervision they can be-good facilitators. Without that support many people with developmental disabilities will continue to produce invalid communication. Worse, people will continue to have their voices silenced while others will forever denied their opportunity to speak.
REFERENCES
Cardinal, D.(1995,May). Validating facilitated communication is about as likely as a Republican Congress. Presentation at the Fourth Annual Facilitated Communication Conference, Syracuse, New York.
Olney, M. (1995, May). Controlled evaluation of facilitated communication: Results and discussion of a validation study. Presentation at the Fourth Annual Facilitated Communication Conference, Syracuse, New York.
Ramsden, J. (1994, March). Facilitated Communication: Validity and instruction. Ph.D. dissertation at University of Oregon, Eugene Oregon.
Simon, E.W., Toll, D.M. & Whitehair, P.M. (I 994). A naturalistic approach to the validation of facilitated communication. Journal of Autism and Developmental Disorders, 24, 647-657.
Vasquez, C.A. (1994). Brief report- A multitask controlled evaluation of facilitated communication. Journal of Autism and Developmental Disorders. 24, 369-379.
Weiss,M.(1994).Presentation on Facilitated Communication Panel
Sponsored by the Developmental Disabilities Protective Agency.
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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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