Evaluating the impact of facilitated communication on the communicative competence of fourteen students with autism

The purpose of this study was to evaluate facilitated communication (FC) as an augmentative or alternative communication system for 14 students attending the Eden Institute in Princeton, NJ. All participants had an independent diagnosis of autism and standardized testing revealed significant deficits in adaptive behavior across all developmental domains. A pretest-posttest design was utilized to (a) determine if any of the participants were immediately capable of communicating through FC (b) if necessary, instruct the participants in the use FC, and (c) determine if this instruction had any impact on their ability to use FC. At the end of 10 weeks of instruction, no participants were able to produce functional, typed communication. Findings are consistent with other quantitative studies that find no support for the cause-effect relationship proposed by FC proponents.The authors would like to extend their sincere thanks to the families and students who made this project possible. Thanks are also extended to Linda Zarubski, who served as a facilitator, and Michael Alessandri for his support and helpful editorial comments.     

Differentiating communication disorders and autism in children

The diagnosis of autism and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), particularly in young children has become a top priority in the fields of mental health and education. Core symptoms include rituals and stereotypies, social skills deficits, and problems in communication. Considerable overlap exists in symptoms for autism spectrum disorders and communication disorders. As a result, distinguishing between these two conditions is one of the most difficult aspects of the assessment enterprise. However, being able to differentially diagnose these two disorders has important implications for the treatment and management of these conditions. This paper provides an overview and critical analysis of these disorders, how they are differentiated, and the specific impact correct diagnosis can have on the selection and efficacy of interventions.     

Interventions to improve communication in autism

Children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these methods in maintenance and generalization of skills suggests that many children with autism will need to have these methods supplemented with less adult-directed activities to increase communicative initiation and carry over learned skills to new settings and communication partners. Providing opportunities for mediated peer interactions with trained peers in natural settings seems to be especially important in maximizing the effects of this intervention.     

A naturalistic approach to the validation of facilitated communication

By manipulating the facilitator's knowledge of a student's just-completed activity, facilitated communication ability and the extent of guiding were assessed. Seven students diagnosed with mental retardation and their facilitators participated in the study. All 7 students were purported at the start of the study to be communicating via facilitation at levels far above what was previously thought possible given their level of intellectual ability. A large degree of facilitator guiding was revealed for each of the 4 facilitators. Minimal evidence of facilitation was found for 4 of the 7 students. One of the 7 students demonstrated validated facilitated communication on two trials.We gratefully acknowledge the assistance of Sherrie Schlecker and Carole Nebhut who served as judges. We express our thanks to Joyce Lentz for assistance in literature review. Douglas Wheeler was kind enough to make available to us his file of unpublished research studies. Marvin Rosen assisted in the initial design phase of the study. We are especially grateful to the students and staff who participated in this study. This study was supported by Elwyn, Inc.     

Naltrexone and communication skills in young children with autism

OBJECTIVE: To evaluate the effect of naltrexone on communication skills of young children with autism. METHOD: Twenty-four children with autism, 3.0 to 8.3 years old (mean 5.1) who were living at home and attending appropriate school programs, participated in a randomized, double-blind, placebo-controlled, crossover trial. Naltrexone, 1.0 mg/kg, or placebo was administered daily for 2 weeks. Communication was evaluated from videotaped samples of seminaturalistic parent-child interaction. Child and parent language were assessed using similar measures. RESULTS: In this heterogeneous sample, the median number of words the child produced on placebo was 9.5 (range 0-124). The median proportion of utterances with echolalia was 0.16. No differences were found between the naltrexone and placebo conditions in any of the measures of children or parents' communication. Significant correlations were found between the child's number of words and developmental quotient (Spearman rho = 0.58, p = .003) and between the child's and parent's number of words (rho = 0.55, p = .005). CONCLUSIONS: Previous studies showed that naltrexone was associated with modest reduction in hyperactivity and restlessness in this group of children with autism. In this short-term study, the medication did not lead to improvement in communication, a core deficit of autism.     

Developing drugs for core social and communication impairment in autism

There are many challenges to studying drug effects on core social and language impairment in autism. Drugs such as fenfluramine, naltrexone, and secretin do not appear to be efficacious for these core symptoms. Risperidone has led to improvement in some aspects of social relatedness when used to treat irritability in autism. More research is needed on the utility of selective serotonin reuptake inhibitors, cholinergic drugs, glutamatergic drugs, and oxytocin for core autistic symptoms.     

Voices from the past: Comparing the rapid prompting method and facilitated communication

Objective: This article briefly reviews the history and damage caused by facilitated communication (FC) and highlights the parallels between FC and the Rapid Prompting Method (RPM).

Background: FC involves a therapist (or facilitator) supporting the hand of a person with autism while a message is typed on a letter board. FC is widely acknowledged to be a pseudoscientific, unsafe, and unethical treatment for people with autism. RPM is a more recent intervention for people with autism that involves the facilitator holding and moving the letter board while the individual with autism moves their own hand. Those who espouse the perceived benefits of FC and RPM make strikingly similar claims of hidden intelligence and extraordinary communication abilities in people with autism following treatment.

Conclusion: Clients, proponents, and practitioners of RPM should demand scientific validation of RPM in order to ensure the safety of people with disabilities that are involved with RPM.