facilitated communication

When I saw facilitated communication (FC) listed as a probably harmful therapy in Lilienfeld's article, I knew I wanted to write about it in my blog. From my "confines [in] the Ivory Tower", I had thought that FC was pretty much dead. There was convincing empirical evidence that (to use Matt's extremely apt analogy), facilitators were essentially using nonverbal children with autism as Ouija boards, and none whatsoever that the "therapy" was actually helping these children to communicate anything other than the facilitators' own messages.

Then I went and saw Autism: The Musical, and was horrified to see FC apparently live and well, as two parents practically wept to hear a fluent message conveyed to them from their previously nonverbal child. A closer look at the child himself revealed him struggling against the facilitator's grasp on his wrist and paying little to no attention to the keyboard. While I do believe that persons with autism may often have better receptive than expressive language abilities, I have little confidence that anyone, autistic or not, could point to the correct letters to spell out a coherent message without actually looking at them.

Later, after the movie, I heard that the parents were apparently continuing to take their son in for regular sessions of FC. I have attached a link to a YouTube video in which you can listen to what I heard: a speech, ostensibly dictated by this child, on the occasion of his bar mitzvah. Slide it up to about the 3:45 mark and listen if you like.



After hearing such an eloquent and moving speech, you will have little trouble understanding what you might not have before: why people get taken in by PHTs, especially ones revolving around developmental disabilities, and why once taken in, they will do almost anything to retain their belief. What parent would want to think that their son did not have that secret gem hiding inside him? Who would want to give up that comfort once they had obtained it?

Lilienfeld lists as the potential harm of FC, "false accusations of child abuse against family members." Obviously, this risk is very serious. But for me, the "indirect" opportunity costs exacted by FC--and by other "fringe" therapies directed at individuals with developmental disabilities--are much more serious than the opportunity costs exacted by ineffective treatments for other classes of disorders. I say this because delaying effective interventions for pervasive developmental disorders has a cumulative cost; developmental achievements build upon each other and failure to achieve some milestone early on may disrupt later progress in a host of other areas. While a client with acrophobia who wastes decades on ineffective treatments may later be able to resolve the issue in 3 hours using an effective strategy, an individual with autism who is denied early effective treatment is unlikely to achieve to their full potential. In the case of treatments for developmental disorders, opportunity costs should not be excluded from the consideration of potential for harm.