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, an update of ASHA's 1995 position statement on FC, 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
It is the position of the American Speech-Language-Hearing Association (ASHA) that Facilitated Communication (FC) is a discredited technique that should not be used. There is no scientific evidence of the validity of FC, and there is extensive scientific evidence—produced over several decades and across several countries—that messages are authored by the "facilitator" rather than the person with a disability. Furthermore, there is extensive evidence of harms related to the use of FC. Information obtained through the use of FC should not be considered as the communication of the person with a disability.
Facilitated Communication (FC)—also referred to as "Assisted Typing," "Facilitated Communication Training," and "Supported Typing"—is a technique that involves a person with a disability pointing to letters, pictures, or objects on a keyboard or on a communication board, typically with physical support from a "facilitator." This physical support usually occurs on the hand, wrist, elbow, or shoulder (Biklen, Winston Morton, Gold, Berrigan, & Swaminathan, 1992) or on other parts of the body.
ASHA first developed a position statement about FC in 1995 due to a lack of scientific validity and reliability (ASHA, 1995). This updated FC position statement takes a stronger stance against the use of FC than did ASHA’s 1995 statement. In the years since that position statement, there has been no credible scientific evidence of benefit and only growing evidence of the lack of efficacy and of the harms of FC. The use of FC risks harm to individuals with communication disabilities in that it may hinder or delay access to appropriate services and effective forms of intervention, 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); and other empirically supported interventions (ASHA, n.d.-a). The harms of FC also include false allegations of sexual abuse (Probst, 2005) and other forms of maltreatment (Boynton, 2012; Chan & Nankervis, 2014; Wombles, 2014).
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). FC is a technique that involves the person with a disability being dependent upon a "facilitator" to produce a message. The use of FC or other "facilitator"-dependent techniques (e.g., Rapid Prompting Method [RPM]; see ASHA's Position Statement on RPM [ASHA, 2018]) is not consistent with the communication rights of autonomy and freedom of expression (Chan & Nankervis, 2014) because the messages do not reflect the voice of the person with a disability but, rather, reflect the communication of the "facilitator." It must not be assumed that messages delivered via FC or any other "facilitator"-dependent technique (e.g., RPM) reflect the communication of the person with a disability. This position statement on FC does not pertain to independent typing without "facilitator" influence.
Recent systematic literature reviews of FC (Hemsley et al., 2018; Schlosser et al., 2014), based on research appropriately designed to determine the effectiveness of FC, demonstrate a lack of scientific studies to support the effectiveness of the technique and a preponderance of scientific evidence demonstrating "facilitator" influence and authorship of messages delivered by FC. In the almost 3 decades since FC was introduced, there has been no empirical evidence that messages composed using FC can be attributed to the person with a disability. Indeed, the conclusions of earlier systematic reviews (Felce, 1994; Jacobson, Mulick, & Schwartz, 1995; Mostert, 2001; Mostert, 2010; Probst, 2005; Schlosser et al., 2014; Wehrenfennig & Surian, 2008) are supported, and there have been no new authorship studies in the peer-reviewed literature since 2014 (Hemsley et al., 2018; Saloviita, Leppänen, & Ojalammi, 2014). That is, there is no scientific evidence that (a) FC provides access to communication or that (b) individuals achieve independence in communication through the use of FC. Rather, there is sufficient scientific evidence—obtained through numerous controlled and objective evaluations of the technique, including peer-reviewed studies—demonstrating that messages produced using FC are authored by the "facilitator" and not by the person with a disability.
Proponents of FC state that the technique reveals previously undetected literacy and communication skills in people with autism and other disabilities. However, these statements are made only on the basis of anecdotal reports, testimonials, and descriptive studies. Clearly, FC 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). As such, the use of FC carries, several negative and harmful consequences in that FC
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).
The substantial and serious risks of FC outweigh any anecdotal reports of its benefit. The scientific evidence against FC, evidence of harms of FC, and potential for future harms to people who use FC and their families cannot be ignored in clinical decision making. SLPs who use FC—despite being informed of and knowing these harms and risks—could face additional risks in terms of their own liability in the event of harms arising to people with disabilities or their families related to the use of FC.
SLPs have a responsibility to inform and warn clients, family members, caregivers, teachers, administrators, and other professionals who are using or are considering using FC that
SLPs also have an ethical responsibility to inform clients, family members, caregivers, teachers, administrators, and other professionals of empirically supported treatments for communication 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 (Allen et al., 2017; Brady et al., 2016; Iacono et al., 2016; Logan et al., 2017; Romski & Sevcik, 2016; Snell et al., 2010; Walker & Snell, 2013). See the Augmentative and Alternative Communication evidence map (ASHA, n.d.-a) for summaries of available research on this topic, and see the Practice Portal on Augmentative and Alternative Communication (ASHA, n.d.-b) for information on a variety of empirically supported intervention approaches and technologies providing access to AAC.
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 on FC is consistent with as many as 19 other national and international professional and advocacy organization statements (Behavior Analysis Association of Michigan, n.d.).
Additional ASHA resources are available to assist with implementation of this position statement:
For information about RPM, another "facilitator"-dependent technique, please refer to the ASHA Position Statement on RPM (ASHA, 2018).
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Index terms: Facilitated Communication, FC, Facilitated Communication Training, Facilitator-Dependent Techniques, Supported Typing, Assisted Typing
Reference this material as: American Speech-Language-Hearing Association. (2018). Facilitated communication [Position Statement]. Retrieved from www.asha.org/policy/
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