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From _Skeptic_ vol. 2, no. 3, 1994, pp. 68-76.
The following article is copyright (c) 1994 by the Skeptics Society,
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FACILITATED COMMUNICATION:
MENTAL MIRACLE OR SLEIGHT OF HAND?
By Gina Green, Ph.D.

The cliche' that "there is nothing new under the sun" applies more than 
ever to the mental health profession today. We seem to be experiencing a 
myriad of new techniques to treat the developmentally disabled, 
Facilitated Communication being one of the most popular, yet in reality 
their underlying characteristics have been seen before. These components 
make up the structure of what might be considered a social movement:
   --Assertions that a new technique produces remarkable effects are 
made in the absence of solid objective evidence, or what little evidence 
there is becomes highly overblown. 
   --Excitement about a possible breakthrough sweeps rapidly through the 
communities of parents, teachers, service providers, and others 
concerned with the welfare of individuals with disabilities. 
   --Eager, even desperate for something that might help, many invest 
considerable financial and emotional resources in the new technique. 
   --In the process, effective or potentially effective techniques are 
ignored. 
   --Few question the basis for the claims about the new treatment or 
the qualifications of the individuals making them. 
   --Anecdotal reports that seem to confirm the initial claims 
proliferate rapidly. 
   --Careful scientific evaluation to determine the real effects of the 
technique are not completed for some time, and can be made more 
difficult than usual by the well-known and powerful effects of 
expectancies. 
   --Some of these techniques have small specific positive effects, or 
at least do minimal harm. 
   --Eventually they fall out of favor, sometimes because they are 
discredited by sound research, sometimes simply because experience 
reveals their lack of efficacy, but probably most often because another 
fad treatment has come on the scene. Each retains some adherents, 
however, and some go relatively dormant for a while only to emerge 
again.
   Parallel phenomena occur in other areas, such as treatments for AIDS, 
cancer, and various psychological problems. At present the field of 
developmental disabilities (especially autism) seems to be experiencing 
an epidemic of novel techniques, or "interventions," as they are called. 
Despite its parallels with other techniques, Facilitated Communication 
(FC) has probably had a greater impact than any other novel intervention 
in the history of treatment for persons with disabilities.
 
How FC Works

How does FC work? If you have never seen it in action it is quite a 
phenomenon to observe. Individuals with "severe communication 
impairments" (e.g., severe mental retardation, autism) are assisted in 
spelling words by "facilitators" (teachers or  parents) who provide 
physical support, most often (at least initially) by holding their hand, 
wrist, or forearm while they point to letters on a keyboard or printed 
letter display. Right before your eyes, a mentally disabled person that 
just previously had virtually no communication skills, suddenly begins 
to spell out words, sentences, and whole paragraphs. Stories are told. 
Answers to questions are given. A child that did not appear to know the 
difference between a dog and an elephant can now be shown a series of 
pictures, correctly identifying them one by one, as his or her hand 
glides deftly over the keyboard, pecking out the correct letters. The 
assumption, of course, is that most of the words spelled in this fashion 
actually originate with the disabled partner and not the facilitator.
   On its face, FC can seem simple and benign, and sometimes looks quite 
convincing. Its main proponents sometimes characterize FC simply as a 
strategy for teaching individuals to point in order to access systems 
like synthetic speech devices and keyboards to augment their 
communication. At the same time, however, they claim that it is a 
revolutionary means of unlocking highly developed literacy, numeracy, 
and communication repertoires in large numbers of individuals previously 
thought to have severe learning difficulties. For all the world it looks 
like a mental miracle, the kind of stuff they make movies about, as in 
"Awakenings."
   The theory is that many such individuals do not have cognitive 
deficits at all, but instead have a presumed neuromotor impairment that 
prevents them from initiating and controlling vocal expression. Their 
average or even above average intelligence is locked away, awaiting 
release. The neuromotor disorder is also presumed to manifest itself in 
"hand function impairments" that make it necessary for someone else to 
stabilize the individual's hand and arm for pointing, and to pull the 
pointing hand back between selections to minimize impulsive or poorly 
planned responding. Candidates for FC are also presumed to lack 
confidence in their abilities, and so require the special touch and 
emotional support of a facilitator to communicate, (i.e., a strap or 
device to hold the person's arm steady will not work).  
   FC thus has an almost irresistible appeal for parents, teachers, and 
other caring persons who struggle mightily to understand and communicate 
with individuals who often do not respond or communicated in return. But 
the very features that make FC so seductive, in combination with some 
other potent factors, have made it a topic of heated debate between 
believers and skeptics since its "discovery" in Australia nearly two 
decades ago. 

Beginnings Down Under

It all began in the 1970s with Rosemary Crossley, a teacher in an 
institution in Melbourne in the Australian state of Victoria. She 
suspected that some of her young charges with severe cerebral palsy had 
far more ability than their physical impairments allowed them to 
demonstrate. When she gave them hand or arm support to help them point 
to pictures, letters, and other stimuli, Crossley became convinced that 
several of the children revealed literacy and math skills that they had 
somehow developed with little or no instruction, despite having lived 
most of their lives in an impoverished institutional environment. 
   Right away there was controversy about the technique that Crossley 
called Facilitated Communication Training. Two people were involved in 
creating the messages, and simple observation could not reveal how much 
each was contributing. Plus, many of the messages Crossley attributed to 
these institutionalized individuals defied plausibility. "Facilitated" 
accusations of abuse  and expressions of wishes for major life changes 
(like leaving the institution) made it imperative to determine whether 
communications actually originated with the disabled individual or the 
facilitator. Matters were complicated by Crossley's emerging status as a 
heroine to many in the deinstitutionalization movement. Eventually, 
after a series of legal proceedings, a young woman with cerebral palsy 
with whom Crossley had developed a special relationship through FC was 
released from the institution to reside with Crossley. The institution 
was closed, and in 1986 Crossley started (with government financial 
support) the DEAL Centre (Dignity through Education and Language) to 
promote alternative communication approaches--principally FC--for 
individuals with severe communication impairments. Use of the method 
spread to programs in Victoria serving persons with various 
disabilities, accompanied by controversies about communications 
attributed to FC users on the basis of subjective reports.  
   Sufficiently serious issues arose to provoke formal statements of 
concern from professionals and parents in 1988, and a government-
sponsored investigation in 1989. Despite Crossley's resistance to 
objective testing (on the basis that FC users refused to cooperate when 
their competence was questioned), some small-scale controlled 
evaluations were conducted in the course of that investigation. When the 
facilitator's knowledge about expected messages was well-controlled 
(more on this later), and the accuracy of messages was evaluated 
objectively, the effect disappeared. The disabled individuals were 
unable to communicate beyond their normal expectation. Instead, it 
appeared that the facilitators were authoring most FC messages, 
apparently without their awareness. These early studies suggested that 
FC was susceptible to a somewhat unusual kind of abuse: Allowing others 
to impose their own wishes, fears, hopes, and agendas on nonspeaking 
individuals.  

A Social 
Movement is Born

At about that time Douglas Biklen, a special education professor from 
Syracuse University, conducted a four week observational study of 21 
DEAL clients said to be autistic, who were reported to engage in high-
level discourse with the help of facilitators. Professor Biklen was 
already established as a leader in the "total inclusion movement," which 
seeks the full-time placement of all students with disabilities, 
regardless of their competencies and needs, in regular classrooms. The 
report describing his first qualitative study of FC, which Biklen said 
was begun "in an attempt not to test hypotheses but rather to generate 
them," appeared in the Harvard Educational Review in 1990. He reported 
that the communication of the individuals he observed (some of whom were 
being "facilitated" for the first time) was sophisticated in content, 
conceptualization, and vocabulary, and contained frequent references to 
feelings, wishes to be treated normally and to attend regular schools, 
and society's treatment of individuals with disabilities. 
   This was in sharp contrast with the well-documented difficulties in 
social, play, cognitive, and communication skills that constitute 
current diagnostic criteria for autism (not to mention that the 
diagnosis is difficult to make and is applied to individuals with a wide 
range of competencies and deficits in all those domains). In his seminal 
article, Biklen mentioned the controversy over the Australian findings, 
but asserted that informal "indicators that communication was the 
person's own were strong enough, in my view, to justify the continuing 
assumption of its validity" [italics added].   
   Some of the indicators he reported observing were disabled 
individuals typing independently or with minimal physical contact with 
the facilitator; content (spelling errors, unexpected word usage, etc.) 
that appeared to be unique to each individual; and facial expressions or 
other signs that the individual understood the communication. He also 
noted that facilitators often could not tell who was doing the spelling 
and that they could be influencing the FC in subtle ways without their 
awareness, and that this could be a problem. Finally, on the basis of 
his uncontrolled observations and the reports of Crossley and other 
facilitators, Biklen decided that autism had to be redefined as a 
problem not of cognition or affect, but of voluntary motor control. He 
returned from Australia to establish the Facilitated Communication 
Institute (FCI) at Syracuse University, and the North American FC 
movement was underway.

The Movement 
Takes Off

Word of FC spread quickly with the help of several media reports of FC 
"miracles." The rate of information exchange increased geometrically, 
feeding the system and driving it forward. FC newsletters, conferences, 
and support networks contributed to the spread of astonishing success 
stories, along with examples of prose and poetry attributed to FC 
authors. The Syracuse FCI began training new facilitators in earnest, in 
workshops that lasted from a few hours to two or three days. At least 
two New England universities became satellite programs of the Syracuse 
FC Institute, as did numerous other private and public agencies that 
provided training and support for facilitators. Initiates (parents, 
paraprofessionals, and professionals in several disciplines) were often 
told that the technique was simple and required no special training. 
They were urged to train others, and to go out and try FC with disabled 
individuals. Thousands did. Soon FC was being heralded as a means of 
"empowering" individuals with severe disabilities to make their own 
decisions and participate fully in society. FC was rapidly becoming the 
Politically Correct treatment of choice.   
      Soon after publication of Biklen's article, special education 
personnel and parents around Syracuse, then throughout the U.S. and 
Canada, adopted FC enthusiastically. Scores of children were placed in 
regular classrooms doing grade-level academic work with "facilitation." 
Decisions about the lives of adults with severe disabilities--living 
arrangements, medical and other treatments, use of hearing aids, and so 
on--were  based on "facilitated" messages without any attempt to verify 
authorship objectively. In many cases FC supplanted other communication 
modes, including vocal speech and augmentative communication systems, 
that do not require another person for message creation. Some 
psychologists, speech pathologists, and others began giving I.Q. and 
other standardized tests with "facilitation," changing diagnoses and 
program recommendations in accordance with the "facilitated" results. 
Suddenly "retarded" individuals were proclaimed to have average or 
above-average intelligence. "Facilitated" counseling and psychotherapy 
were promoted to help FC users deal with personal problems. Colleges and 
universities offered courses on FC. Millions of tax dollars were 
invested in promoting its widespread adoption, with little objective 
evaluation of its validity or efficacy.  

Enter Psi, Exit Science

Not surprisingly, the experience of accomplishing a breakthrough and 
being part of a movement was a heady experience for many facilitators. 
Some, however, reported wondering all along whether the words being 
produced through FC were really coming from their disabled partners. 
Others who had serious doubts about the method from the outset found 
themselves under considerable pressure from parents, peers, and 
employers to adopt the method wholesale and without question. Reports 
that facilitators' private thoughts were being expressed through FC led 
some to conclude that individuals with autism must have telepathy--a 
view espoused by a professor of special education at the University of 
Wisconsin, among others.
   Facilitators were also imbued, explicitly and implicitly, with a 
strong ideology that presents dilemmas for many who want to know who is 
really communicating in FC. Some components of the ideology include: 
   --Assume competence. 
   --Don't test. 
   --Prevent errors. 
   --Expect remarkable revelations in the form of hidden skills as well 
as sensitive personal information. 
   --Use circumstantial, subjective data to validate authorship.
   --Avoid objective scrutiny. 
   --Emphasize "facilitated" over spoken or other communications.  
   Contradictory evidence from the controlled evaluations that had been 
conducted in Australia and those that emerged later in the U.S. were 
mentioned rarely, if at all, in FC training materials and newsletters. 
When that evidence was mentioned it was to criticize the evaluation 
methods and the people who employed them, and to explain away the 
results by saying essentially that FC could not be tested. In short, 
FC's validity was to be accepted largely on faith. With this, science 
was abandoned.       
   Concurrently Biklen, Crossley,  and their colleagues published 
further reports of qualitative studies suggesting that FC was highly 
effective in eliciting unexpected literacy skills from large proportions 
of individuals with severe autism, mental retardation, and other 
disorders. Many of these individuals had received little instruction in 
reading and spelling, or if instruction had been attempted many had not 
appeared to learn very much. How, then, had they developed age-level or 
even precocious literacy skills? According to Biklen they acquired these 
skills from watching television, seeing their siblings do homework, and 
simply being exposed to words pervading the environment. Or perhaps some 
had actually been learning from instruction all along, but because their 
speech was limited they could not demonstrate what they learned. 
   How did they verify their claims? Biklen and his colleagues used 
participant observation and other methods employed by anthropologists, 
sociologists, and educators in field studies of cultures and social 
systems. The research was strictly descriptive, not experimental, and 
employed no objective measurement or procedures to minimize observer 
bias. Despite their acknowledgement of the real possibility of 
facilitator influence in FC, these studies did not control that critical 
variable.  
   Late in 1991 a few parents of students at the New England Center for 
Autism, where I serve as Director of Research, began pressing our 
program to adopt FC. They asked us to make rather drastic changes in 
their childrens' lives on the assumption that messages produced with FC 
represented the childrens' true wishes and competencies. Some were angry 
when we decided instead to use it only under conditions of a small-scale 
experimental study employing the kind of objective evaluation methods 
that we try to apply to all techniques. At that time we could find 
nothing about FC in the research literature, so we consulted respected 
colleagues around the country. Some (in California, surprisingly enough) 
had not heard of it yet. Others invoked a Ouija board analogy or Clever 
Hans effect, and suggested that FC would be a short-lived fad. None knew 
of any objective evidence about FC. To our chagrin, we also encountered 
individuals with scientific training who were promoting the use of FC 
without considering the fundamental question about authorship. 

The Sexual Abuse 
Component

The real possibility that "facilitated" words were those of the 
facilitators was not a cause for much concern as long as the process 
seemed benevolent. Few wished to throw a wet blanket on the euphoria 
created by reports of a breakthrough. But almost from the beginning, 
strange things began to happen: Some FC messages said--or were 
interpreted by facilitators to say--that disabled FC users had been 
abused by family members or caregivers. Often the abuse alleged was 
sexual, and many allegations contained extensive, explicit, pornographic 
details. 
   So many social movements have a sexual component in them, and FC is 
not different. Production of sex abuse allegations usually set in motion 
an inexorable chain of events. Beliefs about FC, the complexities 
inherent in the method, and the fact that the alleged victim may be seen 
as particularly vulnerable because he or she is disabled, now began to 
interact with the zealous pursuit that seems to typify investigations of 
sex abuse allegations. School or program administrators were notified, 
who in turn called in representatives of social services and law 
enforcement agencies. If the accused was a family member with whom the 
FC user resided, that person was either required to leave the home or 
the FC user was placed in foster care. If a parent was accused, both 
parents often faced criminal charges, one for perpetrating the alleged 
abuse, the other for knowing about it and failing to act. Often actions 
were initiated by social service workers to terminate parental custody 
or guardianship. If the accused was a school or program employee, they 
may have been suspended from their job or even fired. A long and trying 
ordeal was virtually guaranteed for all involved. An investigation 
began. Police interrogated the accused, and questioned the alleged 
victim through their facilitator. Other evidence was sought in the 
results of medical and psychological examinations of the alleged victim, 
and interviews with others who may have had information about the 
alleged events. A presumably independent facilitator was sometimes 
called in to try to corroborate the allegation, introducing another 
complexity: There appear to be no established safeguards or objective 
criteria  for ensuring that independent facilitators in fact have no 
access to information about cases, nor for deciding what constitutes 
corroborating "facilitated" content. 
   False allegations have devastating emotional and financial effects on 
the accused and their families, but leaving individuals in situations in 
which they may be abused jeopardizes their physical and emotional 
welfare. It would seem that extreme caution and stringent rules of 
evidence should apply. A number of cases have arisen in which the only 
evidence was a "facilitated" allegation, although there have also been 
reports of cases in which corroborating evidence or confessions were 
obtained. When an allegation is made through FC, two separate but 
related questions must be addressed: Who made the allegation, and did 
the alleged events actually occur? Some courts and investigative bodies 
in Australia, the U.S., and Canada have decided that the first question 
must be answered by controlled testing of FC under conditions where 
independent observers can verify when the facilitator does and does not 
have information necessary to produce communications. If the FC user 
does not convey information accurately and reliably under those 
conditions, and there is no other solid evidence, the legal action is 
usually terminated. That has been the outcome of testing in every case 
of which I am aware, but by the time that determination has been made 
the accused have been traumatized for the better part of a year and have 
spent tens of thousands of dollars defending themselves. Solid 
corroborating evidence would certainly answer the second question--
whether abuse occurred--but it does not follow logically that it answers 
the question about who authored the "facilitated" allegation. 
   Unfortunately, it wasn't until a number of false "facilitated" 
allegations of sexual abuse came to light that FC began to be 
scrutinized closely. As issues about the validity and reliability of FC 
were addressed in courtrooms all over the U.S., critical and questioning 
stories appeared in the print and electronic media. Concurrently (though 
somewhat slowly), results from a rapidly growing number of controlled 
evaluations began to be disseminated, and a few more skeptical voices 
were raised.

How To Test FC

The rationale for conducting controlled observations to determine 
authorship in FC is straightforward: If the disabled FC user is actually 
the source of the messages, then accurate and appropriate messages 
should be produced on virtually every opportunity when the facilitator 
has no knowledge of the expected message. Some controlled evaluations of 
FC have been mandated by legal questions like those just described, but 
a number were carried out by clinicians, researchers, and program 
administrators who simply wanted an objective empirical basis for making 
decisions about FC. Even James "The Amazing" Randi was consulted in the 
early stages of testing, some calling him in to make sure fraud and 
trickery was not involved, others because they genuinely wondered if 
psychic power was the cause. Randi's skepticism of the phenomenon was 
not welcomed by FC supporters. The first major American study was 
conducted by psychologist Douglas Wheeler and colleagues at the O.D. 
Heck Developmental Center in Schenectady, NY, who wanted objective 
evidence to convince skeptics that FC was valid.
   How do you do a controlled study of FC? Recently I analyzed reports 
of 17 evaluations of FC that have appeared or have been accepted for 
publication in peer-reviewed professional journals, and eight presented 
at scientific conferences. The common and critical ingredients were: 
   1. Consent for participation. 
   2. Objective measures, i.e., use of independent, nonparticipating 
observers or judges, "blind" to the conditions in effect, who recorded 
data and/or evaluated the accuracy of FC output. 
   3. Maintenance of physical and emotional support by the facilitator. 
   4. With only a few exceptions, facilitator/FC user dyads who had been 
working together with apparent success for a considerable period before 
formal evaluations were conducted. 
   5. Familiar, common communication contexts (e.g., typical academic 
and language-development activities, discussing everyday events, naming 
or describing familiar pictures or objects). 
   6. Establishment of apparently successful FC in the evaluation 
context.
   7. Control of information available to the facilitator. 
   The necessary control was established in a number of ways. In some 
studies, facilitators were simply asked to look at their partner and not 
the letter display, or were actually screened from the letter display. 
These kinds of tests were suggested by the observation that many 
facilitators focus intently on the letters while their partners look at 
the letters infrequently, if at all. Others presented visual stimuli 
like pictures, objects, or printed materials only to the FC user while 
the facilitator was screened from seeing them. Alternatively, spoken 
questions were presented only to the FC user while their facilitator 
wore earplugs or headphones playing masking noise. Several evaluations 
used a procedure described as "message passing:" FC users were engaged 
in some familiar activities in the absence of facilitators, who then 
used FC to solicit descriptions of the activities. A couple of 
evaluations involved independent facilitators, unfamiliar with the FC 
user, who solicited information that was presumably unknown to the 
facilitator (e.g., the FC user's favorite food, a recent event in their 
life, names of family members, etc.).

The Results

The most telling evaluations used double-blind procedures, in which 
facilitators and their partners saw or heard different items on some 
trials, and the same item on other trials. Neither could tell what 
information their partner was receiving. Responses that corresponded to 
information presented to the facilitator and not to their partner 
provided direct evidence that facilitators were controlling those FC 
productions. Multiple tasks and control procedures were used by several 
investigators. Facilitators in all evaluations had been trained by 
leading proponents of FC, or by others who had had such training. They 
seemed representative of the general population of facilitators, 
including parents, paraprofessionals, teachers, speech pathologists, and 
other human service workers. The sample of FC users in these evaluations 
also appeared representative, comprising a total of 194 children and 
adults with autism, mental retardation, cerebral palsy, and related 
disorders. 
   None of these controlled evaluations produced compelling evidence 
that FC enabled individuals with disabilities to demonstrate unexpected 
literacy and communication skills, free of the facilitator's influence. 
Many messages were produced over numerous trials and sessions, but the 
vast majority were accurate and appropriate to context only when the 
facilitator knew what was to be produced. The strong inference is that 
facilitators authored most messages, although most reported that they 
were unaware of doing so. Sixteen evaluations  found no evidence 
whatsoever of valid productions. A total of 23 individuals with various 
disabilities in nine different evaluations made accurate responses on 
some occasions when their facilitators did not know the answers, but 
most of those productions were commensurate with or less advanced than 
the individuals' documented skills without FC. That is, they were 
primarily single words and an occasional short phrase, produced on some 
trials by individuals whose vocal or signed communication exceeded that 
level, some of whom had documented reading skills before they were 
introduced to FC. For most of these individuals, there was clear 
evidence that on many other trials their facilitators controlled the 
productions. The controlled evaluations also demonstrated that most 
facilitators simply could not tell when and how much they were cueing 
their partners, emphasizing the importance of systematic, controlled 
observations for identifying the source of "facilitated" messages. The 
legal, ethical, and practical implications of these findings are obvious 
and serious. Together with the legal cases and critical media reports, 
they have made it a little more acceptable to voice skepticism about FC.
 
The Proponents Respond:
Parallels With Psychics

Proponents of FC have criticized the controlled evaluations on several 
counts. The parallels of their responses to those received by James 
Randi when he tests psychics are startling. FC supporters, for example, 
argue that incorrect answers were due to lack of confidence, anxiety, or 
resistance on the part of FC users,  who "freeze up" or become offended 
when challenged to prove their competence. Likewise, psychics claim they 
cannot perform in front of video cameras or in the presence of skeptics 
who make them anxious. In the case of FC, if this were true--if testing 
per se destroyed the FC process--participants in the controlled 
evaluations would not have responded at all, or would have produced 
inaccurate responses throughout, not just when their facilitators did 
not know the answers. Instead, many accurate words, descriptions, and 
other responses were produced, but for the most part only when 
facilitators knew what they were supposed to be. 
   Additionally, many evaluations took place in familiar surroundings in 
which individuals had engaged in FC for numerous sessions, with their 
regular facilitators and letter displays. Sessions typically were not 
conducted or were terminated if there were any signs of distress or 
unwillingness to continue. Few refusals were reported. Participants in 
most evaluations completed numerous trials and sessions over extended 
periods of time. Most appeared cooperative, even enthusiastic, 
throughout. Several evaluations were conducted in the context of typical 
FC sessions, using the same types of materials and questions to which 
participants had appeared to respond successfully. Questions were no 
more confrontational or intrusive (perhaps less so) than those often 
asked in regular FC sessions; in fact, many tasks were identical to 
those recommended for FC training, except that conditions were arranged 
so that facilitators could not know all the expected responses. Finally, 
if FC users simply become too anxious to communicate when challenged, 
one has to wonder how they are managing to perform in regular academic 
classrooms, on I.Q. and other tests, in front of TV cameras, and before 
large audiences at FC meetings. And how can they give "facilitated" 
testimony, under questioning by judges and attorneys (which is anxiety 
producing for anyone), as prosecutors in some sexual abuse allegation 
cases are now arguing is their right?
   Another criticism of the controlled evaluations is that the 
facilitators were not familiar with their partners, were inadequately 
trained, or did not provide appropriate "facilitation." That is simply 
not true. As indicated in the summary above, the FC users' preferred 
facilitators participated with them in most evaluations. The only 
exceptions were two studies that assessed initial responsiveness to FC 
with facilitators and FC users who were "beginners" when the evaluation 
started, and a couple of legal cases in which unfamiliar facilitators 
were involved (who nonetheless "facilitated" successfully with the FC 
users before controlled testing began). Many facilitators were trained 
by leading proponents of FC. Most were encouraged to provide whatever 
physical and emotional support they wished during the evaluation. If 
they were not "facilitating" properly, few understandable communications 
would have been produced. Quite the opposite was true. There is a 
peculiar irony in this criticism, however, since proponents offer no 
specific guidelines or standards as to what constitutes sufficient 
training and experience for facilitators. Some facilitators have started 
using the method after reading an article, watching a videotape, or 
attending a brief workshop. When we began to take a look at FC at the 
New England Center for Autism, for example, our three speech-language 
pathologists were trained by Biklen in a two-day workshop. That appeared 
to be the norm at that time (late 1991). A further contradiction is that 
there are reports throughout the descriptive literature on FC that 
facilitators who were complete strangers had some individuals with 
severe disabilities "facilitating" sentences (more, in some cases) in 
their very first session. 

Implausibilities and Inconsistencies

An oft-cited criticism of the controlled evaluations is that they 
required FC users to perform confrontational naming tasks, which 
proponents consider inappropriate because individuals with autism have 
global "word-finding" problems. This argument is implausible for several 
reasons. First, many evaluations did not require FC users to spell 
specific names; descriptions, copying, multiple-choice options, yes/no 
responses, and answers to open-ended questions were just some of the 
other kinds of responses solicited. Second, there is no solid evidence 
that such problems are exhibited by individuals with autism. It can be 
difficult to distinguish words that an individual presumably knows but 
cannot produce from words that they simply do not know, even with 
individuals who at one time had well-developed language (e.g., 
neurologic patients). This would seem to be even more difficult with 
individuals with autism. Even if this rationalization applied to 
individuals with autism, what accounts for the results with the many FC 
users who did not have autism? Additionally, at least three studies 
documented spontaneous oral naming responses by FC users with autism 
that were more accurate than their "facilitated" responses. That 
certainly goes against the "word-finding" hypothesis for those 
individuals. 
   Some FC proponents attribute negative findings to the supposition 
that most FC users are not experienced with the kinds of tasks presented 
to them in the controlled tests. This criticism is especially puzzling. 
By law, the skills of individuals with special needs must be evaluated 
on a regular basis, so most FC users have probably had a great deal of 
test experience. The tasks used in most controlled evaluations were like 
those used to teach and test academic and language skills in classrooms 
and training programs everywhere. In fact, many were precisely the kinds 
of activities that are recommended for FC training, on which the FC 
users in the controlled evaluations had been reported to perform very 
well. Again, if inexperience with the tasks were a plausible 
explanation, FC users should perform equally poorly when their 
facilitators did and did not know the expected answers. That was not the 
case in the controlled evaluations. 
   Finally, FC proponents are inconsistent in claiming that controlled 
testing undermines the FC user's confidence, while in the next breath 
they are quick to tout reports that some attempts at controlled 
evaluations have produced evidence of FC's validity. In other words, 
when the data contradict their claims, experiments are not valid; when 
the data support their claims, experiments are useful. A report from 
Australia (referred to as the IDRP report) said that three individuals 
with disabilities succeeded in "facilitating" the name of a gift they 
were given in the absence of their facilitators, but one was said to 
type his responses independently, without FC. The report provided no 
background information about the individuals, no details about the 
procedures, and described only one controlled trial completed by each 
individual. Another exercise described in a letter to the editor of a 
speech disorders journal claimed that four of five students thought to 
have severe language delays performed remarkably better with FC than 
without on a test of matching pictures to spoken words. The facilitator 
wore headphones but was not screened visually from the nearby examiner 
who was speaking the words, and no expressive communication was required 
of the FC users. At best, these exercises must be considered 
inconclusive, but they have been cited widely by proponents as 
scientific validations of FC. The contradiction inherent in arguing that 
controlled testing interferes with FC while endorsing exercises like 
these seems lost on them. The clear implication is that tests that 
appear to produce evidence supporting beliefs about FC are good, and 
tests that fail to do so are bad.

Silent Skeptics

If FC is so obviously not the mental miracle supporters claim it is, why 
does the movement continue to grow? Why hasn't the scientific community 
made a significant public statement against FC? A number of variables 
probably account for the initial and continuing reluctance of many 
skeptics to speak up. First, scientists in general are cautious about 
drawing conclusions without data. When FC first hit the disability 
community in North America, there were no objective data to be had. A 
rejoinder to Biklen's first report by Australian psychologists Robert 
Cummins and Margot Prior was submitted to the _Harvard Educational 
Review_ early in 1991. Their paper summarized the results of controlled 
tests of the validity of FC and the legal and ethical problems it had 
engendered in Australia. It was not published until late summer 1992, 
and by that time the FC movement already had considerable momentum. Even 
then, many skeptics withheld judgment on the basis that the Australian 
data were limited. This was essentially our reasoning at the New England 
Center for Autism--that some individuals with autism might write or type 
better than they could speak (we knew a few), and that if there were 
some merit to the claims about FC, it would be revealed through careful 
research using objective methodology. 
   At the same time, however, we sensed something ominous in the 
rapidity and zeal with which FC was being applied, the resistance to 
critical scrutiny, and the antiscience stance of many adherents. Even as 
the dark side of the FC story began to unfold, relatively few in 
developmental disabilities who knew how to test the claims about FC 
experimentally wanted to get involved, perhaps thinking that the best 
response was to continue to do sound research in their own areas. Others 
did not to want to be seen as naysayers or debunkers.      
   Cummins and Prior, both with long histories of involvement in 
treatment and research in developmental disabilities, were among the 
first in Victoria to go public with their concerns about FC. Their 
expressions of skepticism and calls for caution were met with hostility 
and personal attacks from FC proponents in Australia, a scenario that 
has repeated itself in the U.S. That suggests another variable, in my 
opinion one of the most potent: It was (is) not Politically Correct in 
many circles to suggest that FC might not be all it appears, or even to 
call for objective evaluation to determine if it is. Those who do are 
likely to be labelled heretics, oppressors of the disabled, inhumane, 
negative, jealous of others' discoveries, "dinosaurs" who cannot accept 
new ideas, and out for financial gain. 

The FC Future

Needless to say, considerable attention and acclaim have accrued to the 
leaders of the FC movement, but as the data and the harms have mounted, 
so has the criticism. Recent months have seen a marked shift in media 
coverage from the glowing reports of miracles that made almost no 
mention of objective evidence (e.g., _PrimeTime Live_) to stories about 
families for whom FC has been anything but a miracle. A documentary on 
the PBS investigative news program, _Frontline_,  honed in on the 
implausibility and lack of empirical support for Biklen's initial 
claims, along with the emerging evidence from experimental evaluations 
showing overwhelmingly that most FC is _facilitator_ communication. 
   The public position of Syracuse University officials appears to be 
that Professor Biklen's notions are simply provoking the furor and 
resistance that all radical new ideas encounter. Perhaps that is the 
case; time and objective data will tell. Time will most certainly be 
required for the legal system to do its part in determining the future 
of the FC movement. A number of cases involving "facilitated" sexual 
abuse allegations are in process at this writing. To my knowledge, there 
has been one conviction so far. Several individuals and families who 
have been cleared of false allegations have filed damage countersuits 
against the facilitators, school and program administrators, and social 
service agencies involved. On January 10, 1994 a civil suit was filed in 
federal District Court for the northern district of New York seeking $10 
million in damages on behalf of a family who were among the first 
victims of FC allegations in the U.S. Among the ten defendants are 
Douglas Biklen and Syracuse University. 
   Finally, if FC is not a mental miracle, is it sleight of hand? By 
this I do not mean there is intentional deceipt on the part of the 
facilitators. Far from it. Most are genuine, honest, caring individuals 
who wish the best for their charges. Herein lies an explanation. The 
power of a belief system to direct thought and action is overwhelming. A 
full and complete explanation for the FC phenomenon is still 
forthcoming, but clearly there are parallels with the ideomotor 
responses that direct dowsing sticks and the Ouija board. As the 
facilitator gently directs the hand to begin typing, letters are formed 
into words and words into sentences. Just as with the Ouija board where 
elaborate thoughts seem to be generated out of thin air while both 
parties consciously try not to move the piece across the board, the 
facilitators do not appear to be conscious that it is them generating 
the communication. Even with the autistic child looking elsewhere, or 
not looking at all (eyes closed), the hand is still rapidly pecking out 
letters as if it were a miracle. Unfortunately there are no miracles in 
mental health. All of us wish FC were true, but the facts simply do not 
allow scientists and critical thinkers to replace knowledge with wish.

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