Not everyone has been as successful with facilitated communication as Kathy Milam, Douglas Biklen, and the children of Classroom 210. A substantial group of people working in the field have either not been able to make it work or see it as a sham. In the beginning, some called the technique "Ouija board communication'' because it required the participation of a non-autistic facilitator. And some of those who have not found the method useful are people who have done exceptional work in the field of autism, particularly in vocational education and developing job opportunities for autistic adults.
Marcia Smith is the staff psychologist at Community Services for Autistic Adults and Children in Rockville, Md. CSAAC runs several group homes that have allowed a large number of autistic adults to leave institutions. The organization has put more than 60 of these people to work in businesses in the Washington, D.C., area. Smith tried facilitated communication with some of her adult clients, and found that they typed "gibberish.'' Even if the method appears to be working, she says, facilitated communication might result in "some kind of situation where your cues are so subtle that you don't realize that basically you're talking to yourself'' through a person with autism.
The question she raises is at the core of the controversy over facilitated communication: How much is the facilitator influencing the communication of the autistic person? The issue heated up again this summer when the Harvard Educational Review--the journal that printed Biklen's first article on the method--published a lengthy debate on the validity of facilitated communication. Robert Cummins and Margot Prior, two Australian psychologists, are reinterpreting tests of facilitated communication done in Australia. Their conclusion: "It is evident that some assistants, through the use either of tactile/visual cues or through the actual imposition of movement, manipulate their clients' responses.'' Biklen has a response to their article, pointing out flaws in their analysis.
The validation issue becomes an enormous ethical or even legal problem when the person who seems to be typing accuses someone of wrongdoing. In a recent case in Australia, Carla, a mentally retarded girl who was not autistic, used facilitated communication to accuse someone of sexual abuse. After a number of tests, a court decided that Carla was not really communicating, but being influenced by a facilitator with an overactive imagination.
Bernard Rimland, director of the Autism Research Institute, reported the Carla case in his newsletter. "Opportunities for checking should be provided where a child can correctly communicate things the facilitator doesn't know--such as what the child did on the weekend,'' Rimland says.
Even with a system of checks, the question of touch remains a problematic one. When a facilitator is successful in getting a child to communicate, psychiatrist James Harris of the Kennedy Krieger Institute at Johns Hopkins suspects they have mastered what he calls "attunement,'' of which touch is a part. Harris says, "The person who is working with the autistic child needs to become attuned to them'' to make any progress at all. But, he says, "the question of attunement--whether it's just a hand on the shoulder or functional communication where you shape the child's hand--needs to be clarified.''
Harris thinks facilitated communication is producing positive results for some kids. He's just not sure which ones. Classrooms for children with autism, he says, also include kids with "autistic-like behaviors'' who may have greater capabilities. "We need better studies of who these children are. What is their communication history, their educational history, their life experiences, their performance on standard tests? I get the idea Biklen has had trouble figuring out how to test.''
Biklen welcomes the kinds of studies Harris is advocating, but he doesn't want to do them. He's an educator, not a psychiatrist, and like other educators who have written about facilitated communication, he is comfortable with the fact that there is often a time lag between the application of a new method and its scientific validation. "In the past, all of this has been less of an issue,'' Harris observes, "because people simply haven't put in as intensive efforts to work with nonverbal autistics.''
Milam believes that the most skeptical critics of facilitated communication may never be convinced of its validity and, therefore, its value. "People need to look at this as a communication tool,'' she says. "We are now allowing these kids to be part of the world, to be people.'' And because they have become different people in the eyes of the world, the expectations everyone has for them are also different.
"People live up or down to others' expectations,'' writes Stephen Calculator, a specialist in communication disorders at the University of New Hampshire, who has studied the facilitated communication debate. It is people's expectations that dramatically affect the quality of others' lives. "I think that's what [student] Graham Tomlinson meant,'' Milam says, "when I asked him, 'How has using facilitated communication changed your life?''
Graham responded, "It haws improved my life you treatme better.'' --A.S.