Questionable Autism Approaches: Facilitated Communication and Rapid Prompting Method

Kim Wombles
http://www.scientificblogging.com/science_autism_spectrum_disorders

Sorting out communication and education pathways for nonverbal or limited verbal children with autism can be daunting. Augmentative and Alternative Communication (AAC) strategies are often a viable means to help nonverbal and preverbal individuals communicate. But two methods, Facilitated Communication (FC) and Rapid Prompting Method (RPM), are not supported by evidence and are instead a potential drain on autism families’ limited resources.

The idea of Facilitated Communication is a noble one, and as defined by Biklen (1991) sounds entirely reasonable:

"Facilitated communication involves hand-over-hand or hand-on-forearm support of students as they point to pictures, letters or objects to augment communication. The facilitator does not guide the students to selections but rather stabilizes the student’s movements and in some cases actually slows the person’s hand as he or she points to a 'Choice.'"

But most reviews of Facilitated Communication find that it is not a reliable, effective, or legitimate communication tool. Kerrin et al. (1998) found:

"This study supports the findings of Eberlin et al. (1993), Myles and Simpson (1994), Smith et al. (1994), Vazquez (1994), and others who have tried to discover objective evidence in support of FC. The participants responded more accurately when the SLP/facilitator could see, in spite of the fact that the SLP/facilitator did not think she was influencing the students' responses and did not intentionally do so."

Miles and Simpson (1996) noted that the evidence indicated that FC was not a valid method, tested whether it had any value as an educational tool, and concluded that it had absolutely no use. Mostert (2001) notes that Biklen:

“...believed that people without communicative ability, generally regarded as lower functioning than those having some use of language for communication, could not be assumed to be lower functioning because of their obvious expressive deficits” (p. 288). 

This is an important concept and one well worth exploring, although it appears that Biklen may have been overzealous in his assumptions that individuals with no exposure or formal education could somehow be hyperlexic and that FC was the way to expose this. Mostert writes:

"The assumptions of FC proponents, while not well formed and severely challenged (e.g., Hudson, 1995; Jacobson et al., 1995; Shane, 1994), have precipitated several empirical reviews of the effectiveness of FC" (p. 288).

If parents are still interested in FC despite its being debunked as both a communication tool and an educational tool, how else to convince them to bypass this approach? Perhaps by considering that Finn et al. (2005) analyzed various forms of treatment for communication disorders based on ten criteria for pseudoscience, and found that Facilitated Communication met eight of the ten criteria for pseudoscience: untestable, unchanged, confirming evidence, anecdotal evidence, inadequate disconnected, grandiose outcomes, and holistic.

Additional evidence demonstrates Facilitated Communication facilitators unconsciously co-opt communication while attributing it to their clients. Moreover, the potential for harm does exist, particularly if unsubstantiated allegations of abuse occur using FC. The AAP (1998) provided the following statements regarding FC in the journal Pediatrics:

"Many families incur substantial expense pursuing these treatments, and spend time and resources that could be used more productively on behavioral and educational interventions. When controversial or unproven treatments are being considered by a family, the pediatrician should provide guidance and assistance in obtaining and reviewing information. The pediatrician should ensure that the child's health and safety, and the family's financial and emotional resources are not compromised." (p. 11-14)

The American Psychological Association (2003) updated its 1994 statement regarding the lack of scientific support for Facilitated Communication and noted that:

"...most schools and treatment centers stopped using the technique in the mid 1990s. Perhaps the saddest part of this story is that the most vocal advocates of this technique continue to use it and insist that it is effective -- despite the disconfirming evidence. As one parent said, even if the technique is merely an illusion, it is an illusion that they wish to continue."

Given that there are many valid Augmentative and Alternative Communication methods for nonverbal children that do not risk the facilitator co-opting the communication, and that have demonstrated their effectiveness for fostering genuine communication, Facilitated Communication should be avoided.

Another method, one that claims to be an educational tool for nonverbal individuals with autism, is Rapid Prompting Method, or Soma® RPM. Soma® RPM was created by an autism mom, Soma Mukhopadhyay,  in an attempt to help Tito, her son with autism, communicate. According to Halo, the organization Ms. Mukhopadhyay set up, her rapid prompting method, or Soma® RPM, "is academic instruction leading towards communication for persons with autism."

"RPM is an empirical and rational teaching method, based upon how the brain works. Academic lessons are intended to stimulate left-brain learning, leading towards communication. 'Behaviors' or stims are used to help determine the student's open learning channels." 

Despite the claim of empiricism and rationalism, there are only two mentions of RPM in the scientific literature or academic databases: Van Acker (2006) and a brief mention in a case study by Gernsbacher in 2004.

Van Acker (2006), in a monthly newsletter covering the latest educational research, writes this about Rapid Prompting:

"RPM is an instructional technique designed to develop academic and communication skills in individuals with severe autism (CBS Broadcasting, 2003). It is "a "Teach-Ask" paradigm for eliciting responses through intensive verbal, auditory, visual and/or tactile prompts." This intervention program was designed by Soma Mukhopadhyay, a teacher and a mother of a child with autism. RPM elicits responses from persons with autism through a combination of intensive verbal, auditory, visual, and tactile prompts. As in FC, the RPM employs the facilitation of the person's hand or arm as he or she types, points, or writes the responses. To date, RPM has yet to be empirically validated." 

Gernsbacher (2004) briefly mentions RPM and Soma Mukhopadhyay:

"RH's mother then had the opportunity to visit with the mother and son in the United States (Mukhopadhyay, 2000). Although RH's mother was unwilling to go to the extreme measures that the Indian mother had used with her son, RH's mother was very motivated to explore the possibilities of RH using even a gross style of handwriting for augmentative communication

The website for Halo/RPM, http://www.halo-soma.org, provides no solid evidence for how this instructional method works. Instead, vague phrasing asserts that "Of course RPM is real." And FAQ assertions that science is providing information regarding how autistic individuals think are contradicted:

"Teaching and learning is an age-old process. It does not take scientific research to realize that children must be taught if they are ever to learn and improve. ASD [autism spectrum disorder] students need not be deprived of teaching and learning opportunities because of diagnosis, differences or doubt about a student's potential."

Though Rapid Prompting Method has been in use for approximately a decade, there are no studies on this method’s effectiveness at helping individuals with autism communicate or master academic material; there are only testimonials. Therefore, it is not possible to assess whether individuals with autism legitimately benefit or gain skills from RPM.

It is also not possible to assess whether RPM responses come from the person with autism, or are a result of the facilitator/prompter's co-opting. Many YouTube and Google videos show facilitator effect  with RPM. And Rapid Prompting Method has never been subjected to the rigor of a scientific study.


Both Facilitated Communication and Rapid Prompting Method are unsubstantiated and -- due to the need for facilitators -- expensive attempts to help nonverbal children with autism learn academic materials and communicate independently. Both methods should be avoided by parents, especially in light of available AAC strategies that do not introduce the opportunity for facilitator co-option. Ensuring that our children's gains are honestly their own and that the communication they engage in is genuine should be every parent's and educator's priority.

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References

Finn, P., Bothe, A., and Bramlett, R. (2005). Science and Pseudoscience in Communication Disorders: Criteria and Applications.American Journal Of Speech-Language Pathology / American Speech-Language-Hearing Association, 14(3), 172-186. Retrieved from MEDLINE database.



GERNSBACHER, M. A. (2004). Language is more than speech: A case study. Journal of Developmental and Learning Disorder, 8, 81-98.

Green, V. (2007). Parental Experience with Treatments for Autism. Journal of Developmental & Physical Disabilities, 19(2), 91-101. doi:10.1007/s10882-007-9035-y.

Kerrin, R., Murdock, J., Sharpton, W., & Jones, N. (1998). Who's doing the pointing? Investigation facilitated communication in a classroom setting with... Focus on Autism and Other Developmental Disabilities, 13(2), 73. Retrieved from Health Source - Consumer Edition database.

Mostert, M. (2001). Facilitated Communication Since 1995: A Review of Published Studies. Journal of Autism and Developmental Disorders, 31(3), 287-313. Retrieved from Psychology and Behavioral Sciences Collection database.

Myles, B., and Simpson, R. (1996). Impact of Facilitated Communication Combined With Direct Instruction on Academic Performance of... Focus on Autism and Other Developmental Disabilities, 11(1), 37. Retrieved from Health Source - Consumer Edition database.

Van Acker, R. (2006). Outlook on Special Education Practice. Focus on Exceptional Children, 38(8), 8-18. Retrieved from Academic Search Complete database.

A version of this essay was originally published on Kim's blog Countering