The Centre for AAC, University of Pretoria, 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. 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 Spelling to Communicate). Concerns have been raised repeatedly about authorship questions in connection with these methods, 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:
- 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);
- There are as yet no studies investigating the efficacy or authorship questions around RPM (Schlosser et al., 2019) or Spelling to Communicate.
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
- 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
- until clear and unequivocal evidence becomes available that shows that that messages composed through RPM and Spelling to Communicate 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.
This position statement is consistent with the position statement of the international Society for Augmentative and Alternative Communication (ISAAC) on FC (see https://www.tandfonline.com/doi/full/10.3109/07434618.2014.971492), and the American Speech-Language Hearing Association's position statements on RPM https://www.asha.org/policy/ps2018-00351/#1 and on FC https://www.asha.org/policy/PS2018-00352/ and their stance on FC, RPM and Spelling to Communicate https://www.asha.org/News/2018/ASHA-Discourages-Use-of-Facilitated-Communication-Rapid-Prompting-Method/
Hemsley, B., Bryant, L., Schlosser, R. W., Shane, H. C., Lang, R., Paul, D., … 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 https://journals.sagepub.com/doi/pdf/10.1177/2396941518821570
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 https://www.tandfonline.com/doi/full/10.3109/07434618.2014.971490
Schlosser, R. W., Hemsley, B., Shane, H., Todd, J., Lang, R., Lilienfeld, S. O., … Odom, S. (2019). Rapid Prompting Method and autism spectrum disorder: Systematic review exposes lack of evidence. Review Journal of Autism and Developmental Disorders, Early onli, 1–10. https://doi.org/10.1007/s40489-019-00175-w https://link.springer.com/article/10.1007/s40489-019-00175-w