Position statement on expressive methods of communication for persons with limited speech that require the input of a trained supporter

The Centre for AAC would like to herewith express its position on expressive methods of communication (for persons with limited speech) that require the input of a trained supporter or facilitator. Examples of such methods include Facilitated Communication (FC), the Rapid Prompting Method (RPM), and Spelling to Communicate (S2C). What these methods have in common is that a trained supporter or facilitator gives some form of physical support to a person with limited speech who is pointing to letters on a board to compose a message. This physical support can be either on the person’s body (index finger, hand, arm, elbow or shoulder) as in the case of FC, or by holding the letter board in front of the person (in the case of RPM and S2C).

From the outset, we want to clarify that spelling, as a form of communication, has long been an accepted AAC method. However, it should only be recommended and used if based on a feature matching process (McMahon et al., 2023), which determined that spelling is the best way for an individual to communicate. Also, as with all other AAC methods, the messages generated should be those of the person using AAC and not those of the facilitator.

Concerns have been raised repeatedly about authorship questions in connection with FC, RPM and S2C, since the physical support provided by the trained facilitator poses a risk that the messages composed are those of the facilitator, and not the person in with limited speech. In this regard it is noteworthy that:

1) Numerous studies have provided unequivocal evidence that messages produced through FC are authored by the facilitator, and not by the person with limited speech (Hemsley et al., 2018; Schlosser et al., 2014)

2) A study by Jaswal et al. (2020) used eye tracking methods to investigate authorship of persons using S2C. The authors indicate that their data “…suggest that participants actively generated their own text” (p. 6). This (suggested) interpretation has been questioned as the method used to determine independent authorship is open to misinterpretation (Beals, 2021). There are as yet no studies using so-called “message passing” tests to investigate the authorship questions around RPM or S2C. (Beals, 2021; Schlosser et al., 2019; Schlosser & Prabhu, 2024).

Since there is a possibility that these methods therefore undermine the agency of the person with limited speech by attributing to them messages composed by the facilitator, it is the position of the Centre for AAC that

1) FC cannot be regarded as a valid form of AAC and its use in clinical practice is strongly discouraged by the Centre for AAC; and that

2) until clear and unequivocal evidence becomes available that shows that that messages composed through RPM and S2C are authored by the person pointing to the letters and not the person holding the board, neither method can be regarded as a valid form of AAC and their use in clinical practice is strongly discouraged by the Centre for AAC.

Furthermore, the Centre for AAC would welcome studies that clarify the authorship question regarding messages composed through RPM and S2C.

This position statement is consistent with the position statement of ISAAC on FC (see https://www.tandfonline.com/doi/full/10.3109/07434618.2014.971492), and the American SpeechLanguage Hearing Association's position statements on FC, RPM and S2C https://www.asha.org/about/press-room/fc-and-rpm/

Last updated: 04 March 2024


References: Beals, K. (2021). A recent eye-tracking study fails to reveal agency in assisted autistic communication. Evidence-Based Communication Assessment and Intervention, 15(1), 46–51. https://doi.org/10.1080/17489539.2021.1918890 Hemsley, B., Bryant, L., Schlosser, R. W., Shane, H. C., Lang, R., Paul, D., Banajee, M., & Ireland, M. (2018). Systematic review of facilitated communication 2014–2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism & Developmental Language Impairments, 3, 1–8. https://doi.org/10.1177/2396941518821570 Jaswal, V. K., Wayne, A., & Golino, H. (2020). Eye-tracking reveals agency in assisted autistic communication. Scientific Reports, 10(1), 1–10. https://doi.org/10.1038/s41598-020-64553-9 McMahon, L. F., Shane, H. C., & Schlosser, R. W. (2023). Using occupational therapy principles and practice to support independent message generation by individuals using AAC instead of facilitated communication. AAC: Augmentative and Alternative Communication, 0(0), 1–7. https://doi.org/10.1080/07434618.2023.2258398 Schlosser, R. W., Balandin, S., Hemsley, B., Iacono, T., Probst, P., & Von Tetzchner, S. (2014). Facilitated communication and authorship: A systematic review. AAC: Augmentative and Alternative Communication, 30(4), 359–368. https://doi.org/10.3109/07434618.2014.971490 Schlosser, R. W., Hemsley, B., Shane, H., Todd, J., Lang, R., Lilienfeld, S. O., Trembath, D., Mostert, M., Fong, S., & Odom, S. (2019). Rapid prompting method and autism spectrum disorder: Systematic review exposes lack of evidence. Journal of Autism and Developmental Disorders, 6(4), 403–412. https://doi.org/10.1007/s40489-019-00175-w Schlosser, R. W., & Prabhu, A. (2024). Interrogating neurotypical bias in facilitated communication, rapid prompting method, and spelling 2 communicate through a humanistic lens. Current Developmental Disorders Reports, Advance on. https://doi.org/10.1007/s40474-024-00296-w

- Author Centre for AAC


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