Position Statement

Rapid Prompting Method

Ad Hoc Committee on Facilitated Communication (FC) and the Rapid Prompting Method (RPM)

About This Document: This position statement is an official policy of the American Speech-Language-Hearing Association (ASHA). The position was developed by the ASHA Ad Hoc Committee on Facilitated Communication (FC) and the Rapid Prompting Method (RPM): Meher Banajee, chair; Bronwyn Hemsley; Russell Lang; Ralf W. Schlosser; Howard C. Shane; and Diane Paul, ex officio. Sandra Gillam, Vice President for Speech-Language Pathology Practice (2015–2017) served as the ASHA Board of Directors (BOD) liaison from August 1, 2017, to December 31, 2017. Marie Ireland, Vice President for Speech-Language Pathology Practice (2018–2020) served as the BOD liaison from January 1, 2018, to August 31, 2018. This position statement was open for peer review by all interested parties, and respondents included speech-language pathologists, audiologists, special educators, other related professionals, professional associations, families, individuals with disabilities, and advocacy groups.

Table of Contents

Position Statement: Rapid Prompting Method

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.

Rationale

Description of the Rapid Prompting Method

The Rapid Prompting Method (RPM), is described as a teaching method "leading towards communication for persons with autism" (Helping Autism for Learning and Outreach [HALO], 2018; Mukhopadhyay, 2008). Information about RPM is available primarily through the HALO website (www.halo-soma.org) and in books by Soma Mukhopadhyay, who developed RPM for her son (Mukhopadhyay, 2008, 2011, 2013, 2014, 2015, 2016a, 2016b, 2017a, 2017b). According to the HALO website, RPM involves pointing to letters "to form words on a letter board, typing device, and/or by handwriting." Untested assertions are that RPM assists with motor planning and that "prompting is necessary in order for the student to initiate a response" (Mukhopadhyay, 2008, p. 139). Although RPM is promoted for use with persons with autism, the HALO website states that RPM is suitable for "most any student." As prescribed by Mukhopadhyay in her books and workshops, RPM involves a series of "teach–ask" trials of graduated difficulty, starting with the student being given or choosing a correct answer from two written options and progressing through to composing responses by pointing to printed letters on a card, stencil, or keyboard (Mukhopadhyay, 2008). Competence is presumed even if not evident, and learning materials are presented verbally and textually at age level. Verbal, auditory, visual, and tactile prompts are used to elicit responses (e.g., ripping paper, handing a student a pencil). In RPM, "prompt dependency is preferred to the alternative of allowing no response or no learning to occur" HALO, n.d.). Although RPM or Soma®RPM is primarily associated with HALO-Soma and Soma Mukhopadhyay, foundationally and procedurally similar alternative forms have appeared, such as "Informative Pointing" (Iversen, 2007), "letterboarding," and "Spelling to Communicate," and this position statement is applicable regardless of the name used for the technique.

Comparison of RPM With FC

RPM bears considerable similarity to Facilitated Communication (FC)—also called "Assisted Typing," "Facilitated Communication Training," and "Supported Typing"—and FC is a pseudoscientific technique that has been discredited, disproven, and found harmful (see ASHA, 2018; Schlosser et al., 2014). Both RPM and FC are "facilitator"-dependent techniques (i.e., techniques that involve the person with the disability being dependent upon a "facilitator" to produce a message; Tostanoski, Lang, Raulston, Carnett, & Davis, 2014). These techniques ostensibly are designed to provide access to alphabet/letter/word boards or speech-generating devices for communication or education. In RPM, the instructor typically does not physically guide the hands of the individual but, rather, holds the letter board and provides repeated verbal, auditory, visual, and/or tactile prompts. See Table 1 for a comparison of characteristics of RPM with those of FC.

ASHA recognizes the human right of communication, as expressed in the United Nations Convention on the Rights of Persons With Disabilities (UNCRPD; United Nations, 2006), the Universal Declaration of Human Rights (UDHR; United Nations, 1948), the International Communication Project (2014), and the Communication Bill of Rights by the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC; Brady et al., 2016). The use of RPM or other "facilitator"-dependent techniques is not consistent with the communication rights of autonomy and freedom of expression and prevents access to the person's human right of communication (Chan & Nankervis, 2014). It must not be assumed that messages produced via RPM or any other "facilitator"-dependent technique (e.g., FC) reflect the communication of the person with a disability. This position statement on RPM does not pertain to independent typing without instructor influence.

Systematic Review of RPM

Schlosser et al. (2017a, 2017b, 2018) recently conducted a systematic review of the literature relating to RPM and people with autism spectrum disorder. The results of this systematic review demonstrated that, to date,

  1. there are no experimental studies of sufficient rigor to demonstrate a link between any communication or education improvements in the person with a disability and the use of RPM; and
  2. the only experimental, peer-reviewed study on RPM that has tested authorship of messages demonstrated instructor influence in producing the messages; there were no correct messages when the instructor was not aware of the answers (Travers, Ayers, Trump, & Cagliani, in press).

Chen, Yoder, Ganzel, Goodwin, and Belmonte (2012), one of the excluded studies in the Schlosser et al. (2017a, 2017b, 2018) review, often is cited incorrectly as providing empirical support for RPM; however, this descriptive, retrospective, correlational study did not attempt to test authorship of the messages produced using RPM (Lang, Tostanoski, Travers, & Todd, 2014) and was not designed to test effectiveness of RPM in terms of communication (Chen et al., 2012). The authors themselves stated, "We defer, for the moment, the crucial question of whether the communications produced during RPM therapy are genuine." In the almost 2 decades since RPM was introduced, three important observations are noted that serve as the basis for not recommending RPM:

  1. The scientific validity and reliability of RPM have not been demonstrated.
  2. There is no scientific evidence supporting the assertion that messages produced using RPM reflect the communication of the person with a disability.
  3. There is one peer-reviewed experimental authorship study testing whether messages produced using RPM are influenced or generated completely by the instructor. This study demonstrates instructor-generated messages using RPM (Travers et al., in press).

Anecdotes about the use of RPM include stories of both benefits and harms. The lack of scientific validity of RPM—and RPM's similarity in characteristics to FC (Tostanoski et al., 2014), as summarized in Table 1—support the following conclusions: (a) the use of RPM risks the production of instructor-dependent messages, (b) the use of RPM may limit opportunities for the person with a disability to access effective interventions, and (c) RPM is a pseudoscience (i.e., a practice incorrectly framed as being based on scientific findings; Finn, Bothe, & Bramlett, 2005; Lof, 2011) and is "junk science" (i.e., faulty information or research used to advance specific interests; Agin, 2006).

Recommendations

Speech-language pathologists (SLPs) are autonomous professionals who are responsible for critically evaluating all treatment techniques in order to hold paramount the welfare of persons served in accordance with the ASHA Code of Ethics (ASHA, 2016). SLPs should be mindful of their own legal and ethical responsibilities and risks; they are obliged to "provide services or dispense products only when benefit can reasonably be expected" and not do harm (ASHA, 2016).

SLPs have a responsibility to inform and warn clients, family members, caregivers, teachers, administrators, and other professionals who are using or are considering using RPM that

  1. there is no evidence that messages produced using RPM reflect the communication of the person with a disability, and therefore there is no evidence that RPM is a valid form of communication;
  2. there is emerging scientific evidence that messages produced using RPM reflect the communication of the instructor and not of the person with disability;
  3. RPM has been compared to FC on several characteristics, and FC is a discredited technique with evidence demonstrating that messages produced using FC do not reflect the communication of the person with disability but are authored by the "facilitator" (Felce, 1994; Jacobson, Mulick, & Schwartz, 1995; Mostert, 2001, 2010; Probst, 2005; Schlosser et al., 2014; Wehrenfennig & Surian, 2008);
  4. the potential harms associated with using RPM include prompt dependency; lost time and money that cannot be retrieved; reduced opportunities for access to timely, effective, and appropriate interventions; and potential loss of individual communication rights; and
  5. ASHA's position on RPM is that the use of RPM is not recommended.

SLPs also have a responsibility to inform clients, family members, caregivers, teachers, administrators, and other professionals of empirically supported treatments for individuals with communication limitations and to advocate for these treatments. Several systematic literature reviews have demonstrated the value of communication interventions for individuals with severe communication disabilities, including augmentative and alternative communication (AAC; see, e.g., Allen, Schlosser, Brock, & Shane, 2017; Brady et al., 2016; Iacono, Trembath, & Erickson, 2016; Logan, Iacono, & Trembath, 2017; Romski & Sevcik, 2016; Snell et al., 2010; Walker & Snell, 2013); Applied Behavior Analysis (ABA; Ivy & Schreck, 2016; Virues-Ortega, 2010; Vismara & Rogers, 2010); Functional Communication Training (Heath, Ganz, Parker, Burke, & Ninci, 2015; Kurtz, Boelter, Jarmolowicz, Chin, & Hagopian, 2011); and other empirically supported interventions. See the Augmentative and Alternative Communication evidence map (ASHA, n.d.-a) for summaries of available research on this topic and the Practice Portal on Augmentative and Alternative Communication (ASHA, n.d.-b). ASHA strongly supports continued research and clinical efforts to develop scientifically valid methods for developing and enhancing the authentic and independent communication and literacy skills of people with­­ disabilities. 

ASHA's position that RPM is not recommended is supported internationally by other professional associations for SLPs (Irish Association of Speech & Language Therapists, 2017; Speech-Language & Audiology Canada, 2018; Speech Pathology Australia, 2012).

Additional ASHA resources are available to assist with implementation of this position statement:

For information about FC, another "facilitator"-dependent technique, please refer to the ASHA Position Statement on FC (ASHA, 2018).

Table 1: Comparison of the Rapid Prompting Method (RPM) With Facilitated Communication (FC)

 Point of Comparison

Rapid Prompting Method (RPM)

("Soma®RPM," "letterboarding," "Spelling to Communicate")

Facilitated Communication (FC)

("Assisted Typing," "Facilitated Communication Training," "Supported Typing")

Notes on Similarities and Differences  

Procedures Used to Elicit Responses

An instructor typically holds (and often moves) a letter board while the individual is asked to point to letters and spell words (HALO, 2018; Mukhopadhyay, 2008). Verbal, auditory, visual, and tactile prompts are used to assist the individual to point to letters (e.g., ripping paper, handing a student a pencil). Stencils with the alphabet, keyboards, and handwriting are also used.

A "facilitator" provides physical support by touching or holding the individual's hand, arm, or shoulder as words are spelled on a letter board or keyboard (Biklen et al., 1991). In some instances, other parts of the body may be touched, or the contact changes from being physical to being gestural.

Confounds affecting both FC and RPM (e.g., the "facilitator's" expectancy bias and ideomotor movements) can be introduced through movement of the individual's hand or movement of the board that the hand touches (Burgess et al., 1998; Tostanoski et al., 2014). The ideomotor effect occurs when thoughts influence movements subconsciously (Burgess et al., 1998).  

Both FC and RPM allow for a notable amount of procedural variation to include the "facilitator" or instructor holding and moving the output device, the individual, or both.

Assumptions About Communication and Literacy Skills

RPM is described on the home page of the HALO website as a "teaching method . . . leading towards communication for persons with autism" (Mukhopadhyay, 2008). As opposed to revealing existing skills, RPM claims to teach individuals new skills, including advanced academic concepts (e.g., reading and spelling). Ultimately, RPM presumes competency in terms of the efficiency of an individual's skill acquisition.  

RPM proponents presume competency in an individual's ability to quickly acquire new skills when prompted on an "open learning channel" (Mukhopadhyay, 2008, p. 91). In writings about RPM, it is claimed that an "open learning channel prompt" involves (a) hypothesizing what form of sensory stimulation is being experienced and then (b) prompting the person in such a way as to compete with that stimulation. For example, an auditory prompt may be given when a person engages in stereotypy that produces sound. This assumption is untested. Alleged evidence of this rapid acquisition of advanced skills (reading, writing, etc.) is provided only when using the method (HALO, 2018; Mukhopadhyay, 2008).

Writings about FC (a) claim that FC unlocks hidden or latent talents in the individual with a disability and (b) presume competency in literacy, spelling, abstract reasoning, and other domains. FC is less likely to be construed as a teaching approach and is more likely to be construed as a key to "liberate" locked-in skills that are already present (Jacobson, Foxx, & Mulick, 2005). Alleged evidence of the authenticity of these abilities is provided only during facilitation (i.e., using the method; Schlosser et al., 2014).

Both FC and RPM rely on presumptions of competency (Travers & Ayres, 2015). Presumption of competency is of concern when it is given more credence in treatment decisions than known facts about the individual or evidence to the contrary (Todd, 2015). The notion of presumed competence can be contrasted with the well-established clinical philosophy that respect for an individual's communication rights is demonstrated by the use of individualized, targeted, and effective treatment approaches.    

In both FC and RPM, the practitioner begins with a set of assumptions derived from a generalized philosophy about the nature of disability rather than on direct empirical assessment data specific to the individual.    

In terms of evidence for or against the procedures:

(a) In FC, there is sufficient scientific evidence demonstrating that facilitated messages are not authored by the individual with a disability (Schlosser et al., 2014). However, FC proponents tend to refute more rigorous studies in favor of less rigorous studies and/or anecdotal reports when those sources support FC's initial presumptions (Emerson, Grayson, & Griffiths, 2001).  

(b) In RPM, there is no empirical evidence to show that prompted messages are authored by the individual with a disability.  

There is one experimental, peer-reviewed study that tested the authorship of RPM messages. This study found evidence of instructor influence (Travers et al., in press).  

The level of skill proficiency claimed to be a result of RPM is a level that educational and psychological research suggests is unlikely (Lang et al., 2014).

Hypothesized Mechanism of Action

RPM is claimed to lead to communication by using "open learning channels" that involve specific sensory modes (visual, auditory, tactile, or kinesthetic), which become activated in a given environment (Mukhopadhyay, 2008, p. 91).

FC is claimed to produce communication by providing physical support to offset deficits in motor planning and control and/or by providing emotional support through touch and presence of the "facilitator" (Biklen et al., 1991; Schlosser et al., 2014).

Although the mechanisms of action claimed to underlie FC and RPM are different, no data supporting either hypothesized mechanism of action have been reported in peer-reviewed research.  

Further, the ideomotor effect has not been controlled in studies of FC or mentioned as a threat in the literature on RPM. Overall, the ideomotor effect remains a more parsimonious explanation for the production of the messages in both methods.  

In their failure to control for the ideomotor effect, both FC and RPM have not demonstrated the validity of their respective mechanisms of action—this characteristic flaw in method is shared by many fad and pseudoscientific approaches (Jacobson et al., 2005).

Research Base/Evidence for Claims of Benefit

RPM avoids peer review and discourages scientific research (Tostanoski et al., 2014). The study often cited as providing empirical support for RPM (see Chen, Yoder, Ganzel, Goodwin, & Belmonte, 2012) is a descriptive, retrospective, correlational study that did not attempt to test authorship of the messages (Lang et al., 2014). Travers et al., (in press) conducted the first experimental study of authorship through RPM and found evidence for instructor influence over the messages using this technique and no evidence that RPM is a valid form of communication.

FC has been studied extensively, and there have been no documented cases of valid communication presented in rigorous controlled research (Schlosser et al., 2014).

For both FC and RPM, there is no credible evidence that messages are authored by the person with a disability, and there is no credible evidence indicating authentic independent communication or any other beneficial outcome arising from FC or RPM (Lang et al., 2014; Tostanoski et al., 2014; Schlosser et al., 2014).

Autonomous Communication

RPM requires an instructor's constant presence. Those using RPM acknowledge the likelihood of—and indicate a preference for—prompt dependency. For example, one page on the RPM website states, "Prompt dependency is preferred to the alternative of allowing no response or no learning to occur" (HALO, n.d.).

FC requires a "facilitator" (Biklen et al., 1991). Although the extent to which the "facilitator" touches the individual may be faded, the "facilitator" is not removed entirely and remains between the individual and the message (Schlosser et al., 2014).

There is no evidence from rigorous peer-reviewed research that independent or autonomous communication has been achieved with either approach.  

Both FC and RPM maintain the person's reliance and dependence on the "facilitator" or instructor to deliver messages via the communication aid.  

Both FC and RPM could result in the person with a disability learning to respond to increasingly subtle cues from the "facilitator" or instructor —nonetheless remaining dependent upon these cues to indicate letters.

Adverse Events/Risk of Harm

There is a risk that the messages produced using RPM are not authored by the individual but are instead authored by the person holding the "letterboard" (Chen et al., 2012). There is also a risk of the loss of time, money, and opportunity for access to effective treatments.  

Other professional associations have warned members against using RPM (Irish Association of Speech & Language Therapists, 2017; Speech Pathology Australia, 2012; Speech-Language & Audiology Canada, 2018).

There is substantial evidence in court records of the harms that have come to people with disabilities and their families relating to the use of FC and false allegations of sexual abuse (Probst, 2005) and other forms of maltreatment, murder, rape, or indecent dealings (Boynton, 2012; Chan & Nankervis, 2014; Wombles, 2014). 

There is extensive commentary in the literature and guidance from as many as 19 professional and advocacy organizations worldwide warning of the harms of FC and recommending against its use as a communication technique (Behavior Analysis Association of Michigan, n.d.).

Both FC and RPM pose a risk in terms of removing the person's access to the human right of communication. Both methods pose a risk that the "facilitator" or instructor—not the person with a disability—is the one authoring the messages. Neither method has provided evidence that any proposed measures taken to reduce this risk are effective.  

Use of either of these techniques may deprive people with disabilities of opportunities to learn to communicate independently.

References 

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Index terms: Rapid Prompting Method, RPM, Facilitator-Dependent Techniques, Facilitated Communication, Letterboarding, Spelling to Communicate


Reference this material as: American Speech-Language-Hearing Association. (2018). Rapid prompting method [Position Statement]. Available from www.asha.org/policy/


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ASHA policy documents contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.


doi:10.1044/policy.PS2018-00351

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