Fact Sheet - Facilitated communication & autism

Adult guides a child’s hands over keyboard

Facilitated communication - extended version

What is the issue?

Facilitated Communication (FC) is a way of helping people who can’t talk to communicate. In FC, a helper called a ‘facilitator’ helps the person to touch or point to letters on a board or keyboard. The facilitator holds the person’s hand, wrist, arm or other body part while the person types. The facilitator’s job is to help the person slow down, to make them more stable or to help them pull back from the keyboard before they type the next letter.

FC was first used with people with cerebral palsy in the 1970s. It started to be used with people on the autism spectrum in the 1990s. Reports about FC often say that the individuals have very good reading and writing skills when they use FC, even when these skills have never been seen before.

FC is argued about because it is hard to know who is really typing the messages: Is it the person with the disability or the person helping them? There has been a lot of research about FC to try to find out who is communicating. It is important to know if the messages made using FC are really coming from the person with the disability.    

What is the idea behind FC?

Supporters of FC think that the communication problems seen in autism are to do with problems with movement, not cognitive or social difficulties. The idea is that by supporting the person’s hand or other body part, the person will be better able to type what they want to say. There are different levels of support. These include holding the hand or finger, elbow support or just touching the person’s shoulder.

What are the problems?

There are a number of concerns about FC. These include:

  • The facilitator needs to be able to guess when the person wants to move. There is a chance that the facilitator might be responding to their own beliefs about what the person wants to type.
  • FC uses a lot of physical support to make the movements, even if the person has good movement for other activities.
  • There is not good evidence about movement difficulties (such as apraxia) in people on the spectrum.
  • Facilitators need to have a strong belief in FC and not all people can learn to be facilitators.
  • The writing done by some people using FC is surprisingly high level, even when it hasn’t been taught. Sometimes, the language and words used are unusual for a person of that age.
  • Sometimes, people using FC choose not to communicate with people close to them, even though they cooperate and interact with them in other ways. It is not clear why this happens.
  • We don’t know why facilitation is needed when some communication devices can now be used by moving a single muscle.
  • Even though there have been many reports about abuse made by people using FC, none have been found to be true.

What does the research say?

Reports that are just based on case studies or descriptions of FC often report good outcomes. Some studies have used more scientific methods. These studies have mostly found that the FC is being influenced, either accidently or on purpose, by the facilitator. Some studies have found that individuals using FC can only answer questions when the facilitator hears the question. If the facilitator doesn’t hear the question, or hears a different question, they produce the wrong answer. Some studies have shown that the facilitator might not realise that they are influencing the person they are trying to help.

A small number of people on the spectrum who start communicating using FC go on to use typing without help. It would be helpful to know more about these people and how they became independent.

In summary

FC is a controversial intervention that is not supported by research.

The American Psychological Association (APA) says:

“facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy”.

Families should talk with a speech pathologist who specialises in complex communication needs for more information.  

(Reviewed in November 2016)