FOI 23.24 0809 Documents Facilitated Communication FULL Dislcosure Log.pdf

DOCUMENT 1
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NDIA Research Paper: Facilitated Communication
Purpose of paper:
This paper has been developed to clarify National Disability Insurance Agency (NDIA) delegate
decision making regarding facilitated communication (FC). Specifically:
a. Is it appropriate for the National Disability Insurance Scheme (NDIS) to fund FC?
b. Does FC meet the reasonable and necessary support criteria, as outlined in the NDIS Act
2013 and NDIS (Supports for Participants) 2013?
The key issue regarding FC as a communication technique is that it is widely discredited and a
potentially harmful and unethical practice, yet it continues to be made available as a support to people
with complex communication needs. Some NDIS providers continue to provide FC support to
participants.
Note: Given the wealth of evidence based research explained in this paper, which clearly identifies
the ethical, legal and choice and control issues associated with FC, and potential to cause harm to the
participant, it is not recommended that NDIS funding be used to access facilitated communication.
Description of support or intervention
FC, also referred to as ‘supported typing’, ‘assisted typing’ or ‘hand over hand’ amongst other things,
is a communication technique that ‘involves a facilitator touching the person with disability’s hand,
elbow, shoulder, body, keyboard or alphabet board (‘rapid prompting’) in order that the person with
disability points, types, or selects messages’1. FC can be traced back to the 1960s in Denmark and
became popular in Australia during the 1970s.
FC is now widely recognised as a discredited and dangerous communication technique and
intervention. There is substantial scientific research evidence, col ected through well designed
controlled trials and reviews that shows facilitators influence the individual’s messages, either
consciously or unconsciously, and that the authorship of messages cannot be considered genuine.
In 1994, the American Psychological Association (APA) declared there was no scientific evidence
proving that FC worked, and that it constituted “immediate threats to the individual civil and human
rights” of the person being facilitated2. One of the primary concerns, both scientific and ethical, was
the issue of “authorship”: whether the thoughts being expressed truly arise from the facilitated, and
not the facilitator.
The APA was soon joined by a range of leading professional and scientific organizations, such as the
American Speech-Language-Hearing Association and the American Academy of Paediatrics, and by
the late ‘90s, facilitated communication proponents were largely dismissed.
Currently in Australia there is general opposition to FC from various organisations operating to assist
people with severe communication disabilities, including The Victorian Advocacy League for
Individuals and Disabilities Inc. (VALID) and Speech Pathology Australia, both holding strong
positions on the subject, based on there being no scientific evidence of its validity.
Despite the prevalent research establishing lack of efficacy and ethical issues and discrediting the
validity of FC in general, it continues to be used by some disability service providers in Australia.
Targeted cohorts
FC can be used by both adults and children with complex communication needs restricting their ability
to communicate and participate freely and independently in the community. The majority of literature
available indicates the technique is predominantly aimed at children with autism and people of al
ages with physical and/or intellectual disabilities compromising communication ability.
1 Speech Pathology Australia, (2012), Augmentative and Alternative Communication Clinical Guideline. Melbourne, Speech
Pathology Australia, p. 29.
2 The American Psychiatric Association Council of Representatives, (1994), Resolution of Facilitated Communication,
https:/ www.apa.org/about/policy/chapter-11
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Overview of literature
The literature review identifies a significant amount of high quality, peer reviewed research on FC,
consistently disproving the efficacy of FC as a legitimate communication technique and disability
support.
In 2018, a Systematic review of facilitated communication 2014–2018 was completed by American
and Australian academics3. The review found no new evidence supporting that messages delivered
using facilitated communication are authored by the person with disability.
This systematic review analysed English language articles about FC published in the peer reviewed
literature since 2014. The review concluded that there:
•  were no new studies on authorship and there remains no evidence that FC is a valid form of
communication for individuals with severe communication disabilities;
•  continue to be no studies available demonstrating that individuals with communication
disabilities are the true authors of the messages generated using FC; and
•  is substantial peer-reviewed literature that is critical of FC and warns against its use.
Personal testimony and anecdotal reports from users are the main available evidence supporting the
use of FC, which cannot alone be considered a reliable, quality evaluating tool.

The only other open source document found in support of FC was a submission to the 2014 Senate
Enquiry into the Prevalence of different types of speech, language and communication disorders and
speech pathology services in Australia. The submission was made by Queensland Facilitated
Communication Training (FCT) ‘FCT QLD Inc.’, which also appears to go by the business name
‘Empowered Facilitated Communication Training’. The credentials or qualifications behind FCT
QLD Inc. are not available and in the submission they identify as:
•  FCT Qld Inc. is an incorporated Association of key stakeholders from a range of backgrounds
that is committed to providing best practice, information and networking to people who require
physical support as an accommodation to movement difference and diversity because “Not
being able to speak does not mean that you have nothing to say”.
The final 2014 Senate Enquiry report did not reference the FCT QLD Inc. submission, which is likely
due to the unscientific nature of the document.
A ful  review and evaluation of available research, including links to references, can be found in
Appendix A.
Associated risks and application under NDIS legislation
In addition to the comprehensive evidence based research discrediting FC as an effective
communication technique, there are further ethical, safety, human rights, and legal risks associated
with the use of FC.
An NDIS funded support must meet all the reasonable and necessary criteria set out in section 34 of
the NDIS Act 2013 and NDIS (Supports for Participants) Rules 2013.
In general, when considering the primary purpose or benefit of facilitated communication (to assist a
person to communicate), it does not meet a number of reasonable and necessary criteria namely
(s34.1.a, b, d) and in inconsistent with General principles outlined in the Act (s4, 4, 6, 8, 10, 11.a, c,
12, 13) and Supports for Participants Rules (2.3.a, b, d, 3.2, 3.3, 5.1).
Good practice
The Supports for Participant Rules 2013 (3.2, 3.3) states that:
•  In deciding whether the support wil  be, or is likely to be, effective and beneficial for a
participant, having regard to current good practice, the CEO is to consider the available
evidence of the effectiveness of the support for others in like circumstances. That evidence
may include:
a)  Published and refereed literature and any consensus of expert opinion;
3 See literature review below.
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b)  The lived experience of the participant or their carers; or
c)  Anything the Agency has learnt through delivery of the NDIS.
There is no quality evidence to support the validity and efficacy of FC as a supported communication
technique, making it not ‘current good practice’.
Choice and control and reasonable risk
A General principle in the NDIS Act 2013 states that:
•  People with disability have the same right as other members of Australian society to be able
to determine their own best interests, including the right to exercise choice and control, and to
engage as equal partners in decisions that wil  affect their lives, to the ful  extent of their
capacity (s4.4.8).
Another General principle in the NDIS Act acknowledges that:
•  People with disability should be supported to exercise choice, including in relation to taking
reasonable risks, in the pursuit of their goals and the planning and delivery of their supports
(s4.4.4).
Choice and control is fundamental in NDIS planning. Typically in planning, if a participant can
demonstrate that all other conventional therapies have been exhausted and they can prove that
alternative therapies are a beneficial support (reasonable risk), they wil  be considered on a case by
case basis.
However, FC is different because it inherently undermines the participant’s capacity for choice and
control and is fundamental y misaligned to this key principle.
FC should not be considered a reasonable risk in planning considerations because the risk of harm
and abuse, combined with the potential to override ones right to communicate their own thoughts
outweighs any perceived benefit.
FC risks a person’s individuality and identity
FC also has the capacity to misrepresent a person’s wishes, personality and individuality and cannot
be viewed as a valid means to communicate important decisions about someone’s life. VALID
highlight this issue in their position statement saying the advocacy league are “concerned that FC
practices, rather than serving to unlock the potential of people with a disability, might actually serve to
obscure and oppress the development of their true character and identity”.
Communication as a human right and consent
There is much addressed in the literature with regard to the human rights and ethics perspective of
FC, with organisations who oppose the technique including such in their positions statements. FC is
incompatible with the concepts of autonomy, freedom of expression, personal agency and self-
determination. Surrounding this is the controversy of sexual abuse, where non-verbal children and
adults purportedly used facilitation to make al egations of sexual abuse against family members, care
givers, and others. For example:
•  The International Society for Augmentative and Alternative Communication (ISAAC) position
statement on FC advises the use of FC appears to be in violation of several articles of the
United Nations Conventions on the Rights of Persons with Disabilities (i.e., Articles 12, 16, 17,
and 21) as it has been shown to prevent individuals without sufficient spoken language from
using their own “voice.”
•  Speech Pathology Australia suggests speech pathologists need to be aware that the act of
using FC to ‘facilitate’ a person to point to letters, words, or messages might expose the
person with complex communication needs to undue influence, manipulation, and
exploitation.
•  The American Psychiatric Association Council of Representatives asserts that specific
activities contribute immediate threats to the individual civil and human rights of the person
with autism or intellectual disability.
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•  VALID is concerned that the personal or professional interests of those who are practising or
promoting FC might sometimes be in conflict with the rights and interests of the person with a
disability.
Typically any NDIS related practice that involves speaking or making decisions on someone else’s
behalf requires formalised legal nominee or guardianship appointments. However expressed consent
cannot be provided reliably using FC.
Article 21 of the UN Convention on the Rights of Persons with Disabilities states that: persons with
disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek,
receive and impart information and ideas on an equal basis with others and through al  forms of
communication of their choice, as defined in article 2 of the present Convention, including by:
(a) Providing information intended for the general public to persons with disabilities in
accessible formats and technologies appropriate to different kinds of disabilities in a timely
manner and without additional cost;
(b) Accepting and facilitating the use of sign languages, Brail e, augmentative and alternative
communication, and al  other accessible means, modes and formats of communication of
their choice by persons with disabilities in official interactions;
For the purposes of the present Convention:
•  “Communication” includes languages, display of text, Brail e, tactile communication, large
print, accessible multimedia as wel  as written, audio, plain-language, human-reader and
augmentative and alternative modes, means and formats of communication, including
accessible information and communication technology4;
Lack of official training or regulated practice
The Raising Children Website, which is funded by Department of Social Services (DSS) Australia,
advises that anyone can become a FC facilitator and to contact an NDIA planner, NDIS early
childhood partner or NDIS local area coordination partner, if looking to find a facilitator. The Raising
Children Website also warns that this intervention can be harmful and has potential risks, including
making a child more passive and less likely to initiate intervention.
For child participants, particularly those accessing supports under ECEI, FC contradicts the capacity
building and early intervention philosophy. ECEI is underpinned by the principle of building capacity to
becoming independent, rather than relying upon someone to guide them in all areas of life, including
communication.
A search of the Australian Skil s Quality Authority (ASQA) database indicated that there were no
registered training organisations or registered courses either existing, or in development, on the
subject of FC.
Desktop research results only found one FC training workshop in Australia being run out of local
organisations in Queensland, such as Uniting Care, by a group called ‘Empowered Facilitated
Communication Training’. The training states that there is ‘no previous experience required… [And]
this workshop is suitable for parents, teachers, support workers and other professionals in the
disability sector’. There are no credentials or qualifications available.
Data Capture
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4 United Nations, (2018), Convention on the Rights of Persons with Disabilities,
https:/ www.un.org/disabilities/documents/convention/convoptprot-e.pdf
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Best practice – Augmentative and Alternative Communication
supports and techniques
As a Commonwealth agency, the NDIA has a duty to represent the interests of people with disability
and align its policies and procedures with evidence based best practice.
FC is a discredited communication technique. Speech Pathology Australia state that:
•  ‘FC remains an approach with little supportive evidence and a preponderance of evidence
that contraindicates its use, and its use is not recommended’5.
There are many other evidence based augmentative and alternative communication (AAC)
techniques and aids and equipment to support a person with complex communication support needs,
that are more appropriate and effective.
There is a large variety of available AAC options and devices on the market. For people whom have
difficulties direct accessing an AAC device; there is a wide range of indirect access methods.
Options include switch scanning, eye gaze and electroencephalogram (EEG) neuro computer
interfaces. Within these options again, there is a wide selection, for example head switches, hand
5 Speech Pathology Australia, (2012), p. 29.
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switches, joy stick, mouth switches breath switches such as sip puff.  Al  of these indirect access
methods, al ow the person with complex communication needs to have autotomy of the messages
they can create and therefore communicate.
Historical y, funding for these best practice communication supports may not have been available or
subsidised in Australia under various state, territory and Commonwealth programs. However with the
advent of the NDIS, any participant who requires speech related therapies or aids and equipment to
support communication, wil  have this funding available to them.
Financial constraints should no longer be a reason for the use of FC over better practice alternatives
and assistive technology for life may in the long term provide a more cost effective option compared
to ongoing per hour therapy/support worker costs. Participants should always be encouraged to use
available funding to access supports that are effective and beneficial.
Further, a recent ‘Review of disability service provision to people who have died while in receipt of
disability services 2017-2018’, conducted by Victorian Disability Services Commission highlights how
effective communication support via a communication assessment is vital, particularly for people with
disability who are at significant risk of health related complications6.
Key Recommendations
The NDIS planning pathway acknowledges that participant support needs vary and whether a support
meets the criteria of reasonable and necessary is always assessed on a case by case basis. A key
priority of the NDIA is placing the participant at the centre of all planning considerations.
The NDIS acknowledges that people are free to choose to pursue any support or service that they
believe provides them with a positive outcome within the scope of the NDIS Act Section 34
reasonable and necessary.
Recommendation 1:
The NDIA cannot reasonably justify NDIS funding being used to purchase FC based on:
•  the established lack of scientific based evidence to substantiate the efficacy of FC;
•  apparent absence of endorsement from reputable peak health bodies;
•  incompatibility with NDIS legislative requirements and General principles; and
•  the potential risk of harm to a NDIS participant.
This position is consistent with that of Speech Pathology Australia and the American Speech and
Hearing Association, the peak national bodies and subject matter experts on augmentative and
alternative communication supports and therapies for people with complex communication needs.
Recommendation 2:
Liaise with the NDIS Quality and Safeguarding Commission to ensure that the risks associated with
FC are communicated effectively.
Recommendation 3:
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Recommendation 4:
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6 Victorian Disability Services Commission, (2018), Review of disability service provision to people who have died while in
receipt of disability services 2017-2018,
’file:// C:/Users/ADO283/Desktop/DSC Reviewofdisabilityserviceprovisiontopeoplewhohavedied 201718.pdf
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Recommendation 5:
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Full Literature Review – Facilitated Communication
Facilitated communication (FC) is a controversial therapeutic approach.
There have been some complaints to the Agency about providers
Brief
providing this therapy service. The Agency would like to develop a
position on this therapeutic approach. (Conference call 24/06/19: Jane
s47F - personal
S
priva
hannon s47F - personal
priv Craig s47F - personal p
Date
08/07/19
Prepared for
Jane s47F - personal pr  (Asst Director TAT Advisory)
Prepared by
Craig
(
s47F - personal
Tactical Research Advisor - TAT/AAT)

Contents
Overview & Research base for FC ........................................................................................ 8
NDIA Internal Research to date ............................................................................................ 9
Definition of Facilitated Communication (FC) ........................................................................ 9
History of Facilitated Communication (FC) ............................................................................ 9
Targeted Cohorts .................................................................................................................. 9
Training & Education of FC Therapists ................................................................................ 10
Human Rights & Ethics ....................................................................................................... 10
Legal Implications ............................................................................................................... 11
Organisations who have guidelines/position statements opposing FC ................................ 11
NDIS Approved Providers offering FC ................................................................................. 12
Literature Search & Summary ............................................................................................. 13
Systematic/Peer Reviews ................................................................................................ 13
Human Rights & Ethics .................................................................................................... 15
Legal Implications ............................................................................................................ 17
Open source information ................................................................................................. 19
Lived Experience ............................................................................................................. 21
Position Statements of organisations opposing FC .......................................................... 22

Overview & Research base for FC
There is a vast amount of literature on the subject. The literature indicates the subject is
highly controversial, and that there is an overwhelming lack of evidence to support FC as a
technique.

The literature search has been categorised into type of evidence using the Evidence Based
Practice, hierarch of evidence, and on the quality of evidence (low, medium or high) based
on the hierarchy, and access to the article (abstract or full article).
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NDIA Internal Research to date
HPRM search indicates an enquiry was made in 2015 by Fiona s47F - personal privacy (Assistant Director
Engagement and Implementation, NDIA) in that NDIA were getting regular queries in
Queensland regarding the use of facilitated communication, because Disability Services
(Qld) had recently rescinded their previous Complex Communication Needs Policy which
endorsed the use of FC, based on recommendations made by Prof Karen Nankervis, Ass
Director, Centre of Excellence for Clinical Innovation and Support, Disability Services Qld. In
June 2019 writer enquired as to an outcome from Fiona regarding her enquiry, with the
feedback: “No outcome that I’m aware of. I’ve had anecdotal feedback from
participants/families that planners don’t enable planning or review discussion to include FC -
e.g. meeting by phone where FC as preferred comms method can’t be used”. (2015 enquiry
HPRN Record: 36016129).
Definition of Facilitated Communication (FC)
FC, (can also be referred to as “facilitated communication training”, “supported typing” or
“hand over hand”) is a technique which attempts to aid communication by people with autism
or other communication disabilities. The facilitator holds the disabled person's arm or hand
during this process and attempts to help them move to type on a keyboard or other device.
The facilitator may provide emotional, communication and physical supports to enable the
person to point reliably to communicate.
History of Facilitated Communication (FC)
FC can be traced back to the 1960s in Denmark. It became popular and gained traction in
Australia during the 1970s, largely due to the ef orts of special educator Rosemary Crossley
who is currently the director of the Anne McDonald Centre in Melbourne.
FC began to emerge internationally in the 1990's and gained popularity and legitimacy at
Syracuse University’s Facilitated Communication Institute (a private research university in
Syracuse, New York), after a professor emeritus was exposed to the technique by Rosemary
Crossley.
In 1994, the American Psychological Association (APA) declared that there was no scientific
evidence proving that FC worked, and that it constituted “immediate threats to the individual
civil and human rights” of the person being facilitated. One of the primary concerns, both
scientific and ethical, was the issue of “authorship”: whether the thoughts being expressed
truly arise from the facilitated, and not the facilitator.
The APA was soon joined by a range of leading professional and scientific organizations,
such as the American Speech-Language-Hearing Association and the American Academy of
Paediatrics, and by the late ‘90s, facilitated communication proponents were largely
dismissed.
Currently in Australia there is a general opposition to FC from various organisations
operating to assist people with severe communication disabilities, including The Victorian
Advocacy League for Individuals and Disabilities Inc. (VALID) and Speech Pathology
Australia, both holding strong positions on the subject, based on there being no scientific
evidence of its validity.
Targeted Cohorts
FC attempts to aid communication by people with autism or other communication disabilities.
The Anne McDonald Centre in Melbourne maintains its services are aimed at people "who
are unable to talk, or to talk clearly, as a result of conditions such as cerebral palsy, strokes,
acquired brain damage, autism, Down syndrome, or intellectual impairment".
The majority of literature available indicates the technique mainly targets people with autism.
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Legal Implications
As with the human rights issues surrounding FC, position statements opposing FC include
the legal implications of the technique, and there is much literature and open source articles
regarding FC being used as evidence in the legal system and courts. There have been many
cases involving accusations using FC particularly of sexual abuse.
Organisations who have guidelines/position statements opposing FC
Australia
•  The Victorian Advocacy League for Individuals and Disabilities Inc. (VALID).
(Summary in Literature search below)
•  Speech Pathology Australia.
(Summary in Literature search below)

New Zealand
•  The New Zealand Ministries of Health and Education.
(Summary in Literature search below)

United States
•  The American Psychiatric Association Council of Representatives (APACR)
(Summary in Literature search below)
•  The New York State Department of Health.
(Summary in Literature search below)
•  The American Speech-Language-Hearing Association (ASHA)
(Summary in Literature search below)
•  The American Academy of Child and Adolescent Psychiatry (AACAP)
•  The American Academy of Paediatrics (AAP)
•  The American Association on Intellectual and Developmental Disabilities (AAIDD),
previously called the American Association on Mental Retardation (AAMR)
•  The American Psychological Association (APA)
Other International
•  The Association for Behaviour Analysis International (ABAI)
•  The Association for Science in Autism Treatment
•  Behaviour Analysis Association of Michigan (BAAM)
•  The Federal Trade Commission (FTC)
•  Heilpädagogische Forschung
•  The Institute on Disability (IOD) at the University of New Hampshire
•  The University of Northern Iowa
•  The International Society for Augmentative and Alternative Communication (ISAAC)
•  National Institute for Health and Care Excellence (NICE)
•  The Scottish Intercollegiate Guidelines Network
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report this synthesis of the extant peer-reviewed

literature on the question of authorship in FC.
Authors conducted a

multi-faceted search
Conclusions reached were that only literature that
including electronic
met level one criteria was deemed to provide
database searches,
scientific evidence of authorship of communicative
ancestry searches,
messages. Three systematic reviews and four
and contacting
individual studies met level one criteria and this
selected authors.
literature provided robust evidence that FC is not
Evidence is classified
a valid technique.
and four levels of
analysis were used.
Mostert, Mark
Facilitated
Previous reviews of Facilitated Communication
Link
2001

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Communication Since
(FC) studies have clearly established that

(Journal of Autism  1995: A Review of
proponents' claims are largely unsubstantiated
and
Published Studies
and that using FC as an intervention for
Systematic Review
Developmental
communicatively impaired or non communicative
Abstract/Preview
Disorders)
individuals is not recommended. However, while
FC is less prominent than in the recent past,

investigations of the technique's efficacy continue.
Examines published
This review examines published FC studies since
studies since the
the previous major reviews by Jacobson, Mulick,
previous major reviews
and Schwartz (1995) and Simpson and Myles
on the subject in 1995,
(1995a). Findings support the conclusions of
updating the subject
previous reviews. However, this review critiques
research time period.
and discounts the claims of two studies purporting

to offer empirical evidence of FC efficacy using

control procedures.
George H. S.
Standards of Proof:
Paper prepared by members of TASH, an
Link
2015

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Singer, Robert H.  TASH, Facilitated
“international leader in disability advocacy”.
Horner, Glen
Communication, and the  Reviews recent developments in the controversy

Dunlap, Mian
Science-Based
over facilitated communication (FC) in light of
Narrative Review
Wang
Practices Movement
major contextual continuities and changes in the
past two decades. The article asserts that series
Abstract
of scholarly reviews of the literature on controlled

experiments have established a preponderance of
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Steven Salzberg   Facilitated
A general article raising concerns of FC as
Link
2018

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Communication Has
unethical but also giving general historical
Been Cal ed An Abuse
information regarding the technique.

(Professor of
Of Human Rights. Why
Editorial
Biomedical
Is It Stil  Around?
Engineering,
Full article
Computer Science,
and Biostatistics at

Johns Hopkins
University)
Smal  general article.
References are cited.
New York Times
The Strange Case of
Feature article regarding the criminal trial of Anna  Link
2015

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Magazine / By
Anna Stubblefield
Stubblefield. Article looks at the arrival of FC in
Daniel Engber
the United States during a hysteria over child

sexual abuse, fuel ed by memories ‘‘recovered’
Editorial
during hypnosis or elicited from children,
indicating that by the end of 1994, some 60 users
Full article
of facilitated communication had made claims of

sexual abuse.
Brings focus on the
amount of sexual
abuse claims using
FC.
Sydney Morning
Suffering at the hands of  Comprehensive article detailing the landmark
Link
1992

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Herald
the protectors
case for the Guardianship and Administration
By Paul Heinrichs
Board . . . the first time an application has been

brought as a result of the issue of facilitated
Editorial
communication.
Full article

No references cited.

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No. 2, p. 233,
Children with Autism
introduction and widespread use of FC in the US
Editorial
1995
Have a Voice in Court?
and examines the clinical debate surrounding FC
Abstract

along with the legal issues of admissibility under
the Frye and Daubert standards.

Nancy Maurer

General article
exploring the debate of
FC and its implications
in the legal system.
Dave Stafford
First impression: Court
An article from the Indianan Lawyer website
Link
2017

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may consider facilitated  regarding the Indiana Court of Appeals al owing a
communication
disabled minor to testify in a civil trial using FC.

Editorial
Full article

General article
highlighting the debate
of the validity of FC
used in the legal
system.
From Autism
Facilitated
An article from the Scientific Review of Mental
Link

1992
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Research Review  Communication: Courts  Health Practice which is a peer-reviewed journal
International, Vol.  say "No"
devoted exclusively to scientifically supported

6 no 3, 1992
claims from scientifical y unsupported claims in
Editorial
clinical psychology, psychiatry, social work, and
allied disciplines.
Full article
A review of the first court decisions in the U.S.

involving allegations of sexual abuse purportedly
A review of a legal
made via facilitated communication where two
case concerning FC
New York judges made independent rulings that
giving policy
allegations made by FC could not be considered
statements from
as evidence because the validity of FC has not
established health
been established.
organisations.

Includes policy FC statements of : American
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Parliament of
Senate Enquiry
An inquiry into the prevalence of different types of  Link
2014
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Australia Senate
Prevalence of different
speech, language and communication disorders
Enquiry
types of speech,
and speech pathology services in Australia.
This senate enquiry
language and
considered over 305
communication
submissions from peak
disorders and speech
bodies across
pathology services in
Australia.
Australia - 2014
Research Autism  Facilitated
General Article from an organisation which is part  Link

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Communication and
of the National Autistic Society in the UK. The

Autism
organisation gives an opinion on the use of
Editorial

facilitated communication, suggesting there is
Full article
high quality evidence indicating that
communication is created by the facilitator.

Smal  opinion article
pinion only does not
cite references.
Wikipedia
Facilitated
Comprehensive entry in Wikipedia
Link

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communication

Editorial / Narrative
Full article

Wel  constructed
narrative and
comprehensively
referenced.
Bronwyn Hemsley  It’s time to stop
General article on FC including history of FC,
Link

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et al
exposing people to the
potential harm, communication rights, reasons to

dangers of Facilitated
not support FC.
Communication
Editorial/Narrative
Professor of
Speech
Full article
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supporters of people using Facilitated
Position of an
Communication should seek independent
established advocacy
assessment, advice and advocacy. The Victorian
organisation based on
Government, through DHS, must develop a set of
an awareness of an
firm and clear policy guidelines to protect people
extensive body of
with a disability from potential exploitation and
independent and peer-
abuse through Facilitated Communication and
reviewed research.
other unreliable and un-validated practices.
(Web: https://www.valid.org.au/)

The
ISAAC Position
Formed in 1983 this organisation exists to create
Link
2014
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International
Statement on Facilitated  worldwide awareness around how Augmentative

Acrobat Document

Society for
Communication
and Alternative Communication can help

Augmentative
individuals without speech. ISAAC does not

Position Statement
and Alternative
support FC as a valid form of AAC, a valid means
Full article
Communication
for people to access AAC, or a valid means to
(ISAAC)
communicate important life decisions. The weight

of evidence does not support FC and therefore it
Wel  researched and

cannot be recommended for use in clinical
practice.
cited document from
an established
This position statement is consistent with the
organisation with
position statements of the following reputable
specific goals related
organizations:
to the subject.
American Academy of Pediatrics (AAP, 1998),
American Academy of Child and Adolescent
Psychiatry (AACAP, 1993), American Association
of Mental Retardation (AAMR, 1995), American
Psychiatric Association Council of
Representatives (APACR, 1994), American
Psychological Association (APA, 1994), American
Speech-Language and Hearing Association
(ASHA, 1995), Association for Behavior Analysis
(ABA, 2005), Association for Science in Autism
Treatment, Autism & Asperger Förbundet (2012),
Behavior Analysis Association of Michigan
(BAAM, 1998), New Zealand Ministries of Health
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and Education (2008), Scottish Intercollegiate
Guidelines Network (2007), Speech Pathology
Australia (2012), Socialstyrelsen (The National
Board of Health and Welfare, Sweden, 2014),
Victorian Advocacy League for Individuals with
Disabilities Inc (VALID, 2012), and
Heilpaedagogische Forschung (2003).
The New Zealand  New Zealand Autism
Evidence Based Practice Guidelines: Autism

2008
s47C - deliberative processes
Ministries of
Spectrum Disorder
Spectrum Disorder document from the ministry.

Acrobat Document
Health and
Guidelines
The summary of recommendations 4.5.2 asserts
  Government
Education
that he use of Facilitated Communication for ASD-
Recommendation
specific symptoms in children with ASD is not
recommended.

Full Article

Wel  researched and
cited government
recommendation.
The New York
Report of the
The "Early Intervention Program Memoranda,
Link
2017

s47C - deliberative processes
State Department  Recommendations -
Guidance and Clinical Practice Guidelines" for the
of Health
Autism / Pervasive
department assert that because of the lack of

Developmental
evidence for efficacy and possible harms of using
Government
Disorders
facilitated communication, it is strongly
recommended that facilitated communication not

Recommendation
be used as an intervention method in young

children with autism.
Full article

Well researched and
cited government
recommendation
within the last 12
months.
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The American
Council Policy Manual:
Position statement of the APA which resolves that  Link

s47C - deliberative processes
Psychiatric
Chapter XI. Scientific
the APA adopt the position that facilitated
Association
Affairs
communication is a controversial and unproved

Council of
communicative procedure with no scientifical y
Narrative Review
Representatives
demonstrated support for its efficacy.
Full article

Position statement of a
large, established
organisation, with
references attached to
their position.
The American
Position Statement
The position of the American Speech-Language-
Link

s47C - deliberative processes
Speech-
Hearing Association (ASHA) is that Facilitated
Language-
Communication (FC) is a discredited technique

Hearing
that should not be used. There is no scientific
Editorial
Association
evidence of the validity of FC, and there is
Full Article
(ASHA)
extensive scientific evidence—produced over

several decades and across several countries—
Position statement of a
that messages are authored by the "facilitator"
large, established
rather than the person with a disability.
disabilities
Furthermore, there is extensive evidence of harms
organisation.
related to the use of FC. Information obtained

through the use of FC should not be considered
as the communication of the person with a
disability.
Barb Trader

Resulting from many members of the TASH
Link
2016

s47C - deliberative processes
Executive
organisation opposing FC and having concerns

Director, TASH
about TASH’s endorsement of the technique,
TASH produced a letter of response from
Editorial
regarding its stance on the validity of FC. TASH
concludes it currently has no official position on
Full article
FC, although they indicate they are firm in the

belief that people have the right to communicate
in the way they find most effective.

Position statement of a
large, established
organisation
Page 25 of 92

DOCUMENT 2
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EC20-000639
Mr Martin Hoffman
Chief Executive Officer
NDIS (National Disability Insurance Agency)
GPO Box 700
CANBERRA ACT 2601
E: xxxxxx.xxxxxxx@xxxx.xxx.xx
Dear  Mr Hoffman
Thank you for your letter of 29 July 2020 about the development of a shared position and policy
between our agencies in relation to Facilitated Communication.
I am aware of the controversy associated with the use of Facilitated Communication as a valid
strategy for people with disability and communication impairment. I would welcome the opportunity
for the National Disability Insurance Agency and the NDIS Commission to work together to develop a
shared approach informed by contemporary evidence.
Once the position is settled, it will be critical to develop policies relevant to our different roles to
support implementation. I agree that the development of a communications strategy will be
essential to signal any relevant changes to NDIS participants, their families and supporters, and
providers who deliver NDIS supports and services.
The Commission’s contact in taking this matter forward is Tracey s47F- personal privacy Director Behaviour
Support: tracey.s47F- personal xxxxxxx@xxxxxxxxxxxxxx.xxx.xx or Tel s47F- personal privacy
Thank you again for raising this matter with me.
Yours sincerely
Graeme Head AO
Commissioner
24 August 2020
T 1800 035 544
PO Box 210
E xxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx.xx
Penrith  NSW 2750
Page 27 of 92
www.ndiscommission.gov.au

DOCUMENT 3
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Position Statement on Facilitated Communication
Overview
• The NDIS Quality and Safeguards Commission (NDIS Commission) Commission and National
Disability Insurance Agency (NDIA) do not support the use of Facilitated Communication as it is
considered by AAC experts to be an unethical technique that is potential y harmful to people
with complex communication needs.
• Renowned national peak and international organisations who are experts in augmentative and
alternative communication (AAC) do not support the use of Facilitated Communication.
• The NDIS Commission and NDIA recommend that NDIS participants with complex communication
needs access services that provide evidence-based interventions and AAC systems that enable
them to communicate independently.
• There is no research evidence that Facilitated Communication is a valid form of communication
for people with severe communication disabilities (Hemsley, et al., 2018) and it has implications
regarding the human rights of people with disability (Chan & Nankervis, 2015).
• There is also research evidence to indicate that there is facilitator influence on the messages
communicated using Facilitated Communication (Schlosser, et al., 2014).
• The NDIS Commission and the NDIA acknowledge that NDIS participants with complex
communication needs may choose to use services that provide a range of communication
interventions, and augmentative and alternative communication (AAC) systems. It is an
underlying principle of the National Disability Insurance Scheme (NDIS) that NDIS participants
have choice and control of their Reasonable and Necessary* Supports.
Position
The NDIS Commission and NDIA do not support the use of NDIS funds for accessing Facilitated
Communication.
Description
Facilitated Communication describes a technique “whereby individuals with disabilities and
communication impairments allegedly select letters by typing on a keyboard while receiving physical
support, emotional encouragement, and other communication supports from facilitators”
(International Society for Augmentative and Alternative Communication, 2014, p357). The person
with disability may receive physical support by having their elbow, shoulder, body, keyboard or
communication board touched or assisted by a facilitator so that they can point, type, or select
messages to communicate (Speech Pathology Australia, 2012). Facilitated communication is also
referred to as ‘supported typing’ and ‘assisted typing’.
Rationale
• Systematic reviews of research literature on Facilitated Communication concluded that there is
no evidence that it is a valid form of communication or that messages generated are authored by
people with severe communication disabilities (Hemsley, et al., 2018, Schlosser, et al., 2014).
• Scientific literature implies that Facilitated Communication contravenes a number of articles of
the United Nations Conventions on the Rights of Persons with Disabilities (2006), of which
Australia is a signatory (e.g., Chan & Nankervis, 2015).
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•  Renowned peak national and international organisations that promote evidence-based practices
in AAC recommend that Facilitated Communication should not be used and that it may harm
people with disabilities due to potential facilitator influence, manipulation or exploitation
(American Speech-Language-Hearing Association, 2018; International Society for Augmentative
and Alternative Communication, 2014; Speech Pathology Australia, 2012; Victorian Advocacy
League for Individuals and Disabilities Inc.; 2014).
Recommendations

•  There are many evidence-based augmentative and alternative communication (AAC) systems
(i.e., techniques, communication devices or equipment) available to support people with
complex communication support needs that are more appropriate and effective than Facilitated
Communication.
•  NDIS participants should be supported to transition from the use of Facilitated Communication
to evidence-based interventions and AAC systems.
•  NDIS participants should obtain an assessment by a multidisciplinary team with expertise in
evidence-based interventions and AAC systems.  The AAC assessment should focus on the
participant’s communication and cognitive competence, optimal positioning and access methods
to promote independent communication.

Reference list
(To be finalised)

Page 29 of 92

DOCUMENT 5
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From:
Clark, Deb
To:
s47F - personal privacy s47F - personal privacy
Subject:
FW: Articles as requested [SEC=OFFICIAL]
Date:
Wednesday, 10 March 2021 8:06:38 AM
Attachments:
image001.jpg
FC Key Summary Points 2019 May.docx
FC Facilitated Communication and Authorship A Systematic Review.pdf
FC FAQs Practice Implications for ASHA"s Position Statements on Facilitated Communication (FC) and the
Rapid Prompting Method (RPM).pdf
image002.png
Deb Clark
Branch Manager
Technical Advisory Branch
National Disability Insurance Agency
T s47F - personal privacy M s47F - personal privacy E deb.s47F - xxxxxxx@xxxx.xxx.xx

NDIA logo.png
The NDIA acknowledges the Traditional Custodians of Country throughout Australia and
their continuing connection to land, sea and community. We pay our respects to them
and their cultures and to Elders past, present and emerging.
From: s47F - personal xxxxxxx@xxxxxxxxxxxxxx.xxx.xx>
Sent: Wednesday, 10 February 2021 2:16 PM
To: s47F - personal xxxxxxx@xxxx.xxx.xx>
Subject: Articles as requested [SEC=OFFICIAL]
Kind regards,
Jeff
Jeffrey
Ph.D
s47F - personal
Senior Practitioner, Behaviour Support
s47F - personal privacy
www.ndiscommission.gov.au
The NDIS Quality and Safeguards Commission acknowledges the traditional owners of country throughout Australia
and their continuing connection to land, sea and community. We pay our respects to them and their cultures, and to
elders both past and present.
Page 31 of 92

DOCUMENT 7
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NDIA Research Paper: Facilitated Communication
Purpose of paper:
This paper has been developed to clarify National Disability Insurance Agency (NDIA) delegate
decision making regarding facilitated communication (FC). Specifically:
a. Is it appropriate for the National Disability Insurance Scheme (NDIS) to fund FC?
b. Does FC meet the reasonable and necessary support criteria, as outlined in the NDIS Act
2013 and NDIS (Supports for Participants) 2013?
The key issue with FC is that it is a communication technique that is a widely discredited and a
potentially harmful and unethical practice, yet it continues to be made available as a support to people
with complex communication needs. Some NDIS providers continue to provide FC support to
participants.
Note: Given the wealth of evidence based research explained in this paper, which clearly identifies
the ethical, legal and choice and control issues associated with FC, and potential to cause harm to the
participant, it is not recommended that NDIS funding be used to access facilitated communication.
Description of support or intervention
FC, also referred to as ‘supported typing’, ‘assisted typing’ or ‘hand over hand’ amongst other things,
is a communication technique that ‘involves a facilitator touching the person with disability’s hand,
elbow, shoulder, body, keyboard or alphabet board (‘rapid prompting’) in order that the person with
disability points, types, or selects messages’1. FC can be traced back to the 1960s in Denmark and
became popular in Australia during the 1970s.
FC is now widely recognised as a discredited and dangerous communication technique and
intervention. There is substantial scientific research evidence, col ected through well designed
controlled trials and reviews that shows facilitators influence the individual’s messages, either
consciously or unconsciously, and that the authorship of messages cannot be considered genuine.
In 1994, the American Psychological Association (APA) declared that there was no scientific evidence
proving that FC worked, and that it constituted “immediate threats to the individual civil and human
rights” of the person being facilitated2. One of the primary concerns, both scientific and ethical, was
the issue of “authorship”: whether the thoughts being expressed truly arise from the facilitated, and
not the facilitator.
The APA was soon joined by a range of leading professional and scientific organizations, such as the
American Speech-Language-Hearing Association and the American Academy of Pediatrics, and by
the late ‘90s, facilitated communication proponents were largely dismissed.
Currently in Australia there is a general opposition to FC from various organisations operating to
assist people with severe communication disabilities, including The Victorian Advocacy League for
Individuals and Disabilities Inc. (VALID) and Speech Pathology Australia, both holding strong
positions on the subject, based on there being no scientific evidence of its validity.
Despite the prevalent research establishing lack of efficacy and ethical issues and discrediting the
validity of FC in general, it continues to be used by some disability service providers in Australia.
Targeted cohorts
FC can be used by both adults and children with complex communication needs restricting their ability
to communicate and participate freely and independently in community. The majority of literature
available indicates the technique is predominantly aimed at children with autism and people of al
ages with intellectual disabilities compromising communication ability.
1 Speech Pathology Australia, (2012), Augmentative and Alternative Communication Clinical Guideline. Melbourne, Speech
Pathology Australia, p. 29.
2 The American Psychiatric Association Council of Representatives, (1994), Resolution of Facilitated Communication,
https:/ www.apa.org/about/policy/chapter-11
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Overview of literature
The literature review identifies a significant amount of high quality, peer reviewed research on FC,
consistently disproving the efficacy of FC as a legitimate communication technique and disability
support.
In 2018, a Systematic review of facilitated communication 2014–2018 was completed by American
and Australian academics3. The review found no new evidence supporting that messages delivered
using facilitated communication are authored by the person with disability.
This systematic review analysed English language articles about FC published in the peer reviewed
literature since 2014. The review concluded that there:
•  were no new studies on authorship and there remains no evidence that FC is a valid form of
communication for individuals with severe communication disabilities;
•  continue to be no studies available demonstrating that individuals with communication
disabilities are the true authors of the messages generated using FC; and
•  is substantial peer-reviewed literature that is critical of FC and warns against its use.
Personal testimony and anecdotal reports from users are the main available evidence supporting the
use of FC, which cannot alone be considered a reliable, quality evaluating tool.

The only other open source document found in support of FC was a submission to the 2014 Senate
Enquiry into the Prevalence of different types of speech, language and communication disorders and
speech pathology services in Australia. The submission was made by Queensland Facilitated
Communication Training (FCT) ‘FCT QLD Inc.’, which also appears to go by the business name
‘Empowered Facilitated Communication Training’. The credentials or qualifications behind FCT
QLD Inc are not available and in the submission they identify as:
•  FCT Qld Inc is an incorporated Association of key stakeholders from a range of backgrounds
that is committed to providing best practice, information and networking to people who require
physical support as an accommodation to movement difference and diversity because “Not
being able to speak does not mean that you have nothing to say”.
The final 2014 Senate Enquiry report did not reference the FCT QLD Inc submission, which is likely
due to the unscientific nature of the document.
A ful  review and evaluation of available research, including links to references, can be found in
Appendix A.
Associated risks and application under NDIS legislation
In addition to the comprehensive evidence based research discrediting FC as an effective
communication technique, there are further ethical, safety, human rights, and legal risks associated
with the use of FC.
An NDIS funded support must meet all the reasonable and necessary criteria set out in section 34 of
the NDIS Act 2013 and NDIS (Supports for Participants) Rules 2013.
In general, when considering the primary purpose or benefit of facilitated communication (to assist a
person to communicate), it does not meet a number of reasonable and necessary criteria namely
(s34.1.a, b, d) and in inconsistent with General principles outlined in the Act (s4, 4, 6, 8, 10, 11.a, c,
12, 13) and Supports for Participants Rules (2.3.a, b, d, 3.2, 3.3, 5.1).
Good practice
The Supports for Participant Rules 2013 (3.2, 3.3) states that:
•  In deciding whether the support wil  be, or is likely to be, effective and beneficial for a
participant, having regard to current good practice, the CEO is to consider the available
evidence of the effectiveness of the support for others in like circumstances. That evidence
may include:
a)  Published and refereed literature and any consensus of expert opinion;
3 See literature review below.
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•  VALID is concerned that the personal or professional interests of those who are practising or
promoting FC might sometimes be in conflict with the rights and interests of the person with a
disability.
Typically any NDIS related practice that involves speaking or making decisions on someone else’s
behalf requires formalised legal nominee or guardianship appointments. However expressed consent
cannot be provided reliably using FC.
Article 21 of the UN Convention on the Rights of Persons with Disabilities states that: persons with
disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek,
receive and impart information and ideas on an equal basis with others and through al  forms of
communication of their choice, as defined in article 2 of the present Convention, including by:
(a) Providing information intended for the general public to persons with disabilities in
accessible formats and technologies appropriate to different kinds of disabilities in a timely
manner and without additional cost;
(b) Accepting and facilitating the use of sign languages, Brail e, augmentative and alternative
communication, and al  other accessible means, modes and formats of communication of
their choice by persons with disabilities in official interactions;
For the purposes of the present Convention:
•  “Communication” includes languages, display of text, Brail e, tactile communication, large
print, accessible multimedia as wel  as written, audio, plain-language, human-reader and
augmentative and alternative modes, means and formats of communication, including
accessible information and communication technology4;
Lack of official training or regulated practice
The Raising Children Website, which is funded by Department of Social Services (DSS) Australia,
advises that anyone can become a FC facilitator and to contact an NDIA planner, NDIS early
childhood partner or NDIS local area coordination partner, if looking to find a facilitator. The Raising
Children Website also warns that this intervention can be harmful and has potential risks, including
making a child more passive and less likely to initiate intervention.
For child participants, particularly those accessing supports under ECEI, FC contradicts the capacity
building and early intervention philosophy. ECEI is about building capacity to becoming independent,
rather than relying on someone to guide them.
A search of the Australian Skil s Quality Authority (ASQA) database indicated that there were no
registered training organisations or registered courses either existing, or in development, on the
subject of FC.
Desktop research results only found one FC training workshop in Australia being run out of local
organisations in Queensland, such as Uniting Care, by a group called ‘Empowered Facilitated
Communication Training’. The training states that there is ‘no previous experience required… [And]
this workshop is suitable for parents, teachers, support workers and other professionals in the
disability sector’. There are no credentials or qualifications available.
Data Capture
s47E(d) - certain operations of agencies
4 United Nations, (2018), Convention on the Rights of Persons with Disabilities,
https:/ www.un.org/disabilities/documents/convention/convoptprot-e.pdf
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s47E(d) - certain operations of agencies
Best practice – Augmentative and Alternative Communication
supports and techniques
As a Commonwealth agency, the NDIA has a duty to represent the interests of people with disability
and align its policies and procedures with evidence based best practice.
FC is a discredited communication technique. Speech Pathology Australia state that:
•  ‘FC remains an approach with little supportive evidence and a preponderance of evidence
that contraindicates its use, and its use is not recommended’5.
There are many other evidence based augmentative and alternative communication techniques and
aids and equipment to support a person with complex communication support needs, that are more
appropriate and effective.
There is a large variety of available AAC options and devices on the market. For people whom have
difficulties direct accessing an AAC device; there is a wide range of indirect access methods.
Options include switch scanning, eye gaze and electroencephalogram (EEG) neuro computer
interfaces. Within these options again, there is a wide selection, for example head switches, hand
switches, joy stick, mouth switches breath switches such as sip puff.  Al  of these indirect access
5 Speech Pathology Australia, (2012), p. 29.
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methods, al ow the person with complex communication needs to have autotomy of the messages
they can create and therefore communicate.
Historical y, funding for these best practice communication supports may not have been available or
subsidised in Australia under various state, territory and Commonwealth programs. However with the
advent of the NDIS, any participant who requires speech related therapies or aids and equipment to
support communication, wil  have this funding available to them.
Financial constraints should no longer be a reason for the use of FC over better practice alternatives
and assistive technology for life may in the long term provide a more cost effective option compared
to ongoing per hour therapy costs. Participants should always be encouraged to use available funding
to access supports that work.
Further, a recent ‘Review of disability service provision to people who have died while in receipt of
disability services 2017-2018’, conducted by Victorian Disability Services Commission highlights how
effective communication support via a communication assessment is vital, particularly for people with
disability who are at significant risk of health related complications6.
Key Recommendations
Generally, NDIS planning acknowledges that participant support needs vary and whether a support
meets the criteria of reasonable and necessary is always assessed on a case by case basis. A key
priority of the NDIA is placing the participant at the centre of all planning considerations.
The NDIS acknowledges that people are free to choose to pursue any support or service that they
believe provides them with a positive outcome within the scope of reasonable and necessary.
Recommendation 1:
However, the NDIA cannot reasonably justify NDIS funding being used to purchase FC based on:
•  the established lack of scientific based evidence to substantiate the efficacy of FC;
•  apparent absence of endorsement from reputable peak health bodies;
•  incompatibility with NDIS legislative requirements and General principles; and
•  the potential risk of harm to a NDIS participant.
This position is consistent with that of Speech Pathology Australia and the American Speech and
Hearing Association, the peak national bodies and subject matter experts on augmentative and
alternative communication supports and therapies for people with complex communication needs.
Recommendation 2:
Liaise with the NDIS Quality and Safeguarding Commission (the Commission) to ensure that the risks
associated with FC are communicated effectively.
Recommendation 3:
s47C - deliberative processes
Recommendation 4:
s47C - deliberative processes
6 Victorian Disability Services Commission, (2018), Review of disability service provision to people who have died while in
receipt of disability services 2017-2018,
’file:// C:/Users/ADO283/Desktop/DSC Reviewofdisabilityserviceprovisiontopeoplewhohavedied 201718.pdf
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s47C - deliberative processes
Recommendation 5:
s47C - deliberative processes
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NDIA Internal Research to date
HPRM search indicates an enquiry was made in 2015 by Fiona s47F - personal privacy (Assistant Director
Engagement and Implementation, NDIA) in that NDIA were getting regular queries in
Queensland regarding the use of facilitated communication, because Disability Services
(Qld) had recently rescinded their previous Complex Communication Needs Policy which
endorsed the use of FC, based on recommendations made by Prof Karen Nankervis, Ass
Director, Centre of Excellence for Clinical Innovation and Support, Disability Services Qld. In
June 2019 writer enquired as to an outcome from Fiona regarding her enquiry, with the
feedback: “No outcome that I’m aware of. I’ve had anecdotal feedback from
participants/families that planners don’t enable planning or review discussion to include FC -
e.g. meeting by phone where FC as preferred comms method can’t be used”. (2015 enquiry
HPRN Record: 36016129).
Definition of Facilitated Communication (FC)
FC, (can also be referred to as “facilitated communication training”, “supported typing” or
“hand over hand”) is a technique which attempts to aid communication by people with autism
or other communication disabilities. The facilitator holds the disabled person's arm or hand
during this process and attempts to help them move to type on a keyboard or other device.
The facilitator may provide emotional, communication and physical supports to enable the
person to point reliably to communicate.
History of Facilitated Communication (FC)
FC can be traced back to the 1960s in Denmark. It became popular and gained traction in
Australia during the 1970s, largely due to the ef orts of special educator Rosemary Crossley
who is currently the director of the Anne McDonald Centre in Melbourne.
FC began to emerge internationally in the 1990's and gained popularity and legitimacy at
Syracuse University’s Facilitated Communication Institute (a private research university in
Syracuse, New York), after a professor emeritus was exposed to the technique by Rosemary
Crossley.
In 1994, the American Psychological Association (APA) declared that there was no scientific
evidence proving that FC worked, and that it constituted “immediate threats to the individual
civil and human rights” of the person being facilitated. One of the primary concerns, both
scientific and ethical, was the issue of “authorship”: whether the thoughts being expressed
truly arise from the facilitated, and not the facilitator.
The APA was soon joined by a range of leading professional and scientific organizations,
such as the American Speech-Language-Hearing Association and the American Academy of
Pediatrics, and by the late ‘90s, facilitated communication proponents were largely
dismissed.
Currently in Australia there is a general opposition to FC from various organisations
operating to assist people with severe communication disabilities, including The Victorian
Advocacy League for Individuals and Disabilities Inc. (VALID) and Speech Pathology
Australia, both holding strong positions on the subject, based on there being no scientific
evidence of its validity.
Targeted Cohorts
FC attempts to aid communication by people with autism or other communication disabilities.
The Anne McDonald Centre in Melbourne maintains its services are aimed at people "who
are unable to talk, or to talk clearly, as a result of conditions such as cerebral palsy, strokes,
acquired brain damage, autism, Down syndrome, or intellectual impairment".
The majority of literature available indicates the technique mainly targets people with autism.
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Legal Implications
As with the human rights issues surrounding FC, position statements opposing FC include
the legal implications of the technique, and there is much literature and open source articles
regarding FC being used as evidence in the legal system and courts. There have been many
cases involving accusations using FC particularly of sexual abuse.
Organisations who have guidelines/position statements opposing FC
Australia
•  The Victorian Advocacy League for Individuals and Disabilities Inc. (VALID).
(Summary in Literature search below)
•  Speech Pathology Australia.
(Summary in Literature search below)

New Zealand
•  The New Zealand Ministries of Health and Education.
(Summary in Literature search below)

United States
•  The American Psychiatric Association Council of Representatives (APACR)
(Summary in Literature search below)
•  The New York State Department of Health.
(Summary in Literature search below)
•  The American Speech-Language-Hearing Association (ASHA)
(Summary in Literature search below)
•  The American Academy of Child and Adolescent Psychiatry (AACAP)
•  The American Academy of Pediatrics (AAP)
•  The American Association on Intellectual and Developmental Disabilities (AAIDD),
previously called the American Association on Mental Retardation (AAMR)
•  The American Psychological Association (APA)
Other International
•  The Association for Behaviour Analysis International (ABAI)
•  The Association for Science in Autism Treatment
•  Behaviour Analysis Association of Michigan (BAAM)
•  The Federal Trade Commission (FTC)
•  Heilpädagogische Forschung
•  The Institute on Disability (IOD) at the University of New Hampshire
•  The University of Northern Iowa
•  The International Society for Augmentative and Alternative Communication (ISAAC)
•  National Institute for Health and Care Excellence (NICE)
•  The Scottish Intercollegiate Guidelines Network
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DOCUMENT 8
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Facilitated Communication
The content of this document is OFFICIAL.
Please note:
The research and literature reviews collated by our TAB Research Team are not to be shared
external to the Branch. These are for internal TAB use only and are intended to assist our
advisors with their reasonable and necessary decision-making.
Delegates have access to a wide variety of comprehensive guidance material. If Delegates
require further information on access or planning matters, they are to call the TAPS line for
advice.
The Research Team are unable to ensure that the information listed below provides an
accurate & up-to-date snapshot of these matters
Research question:
What is the evidence base for Facilitated Communication?
What are the risks or harms associated with Facilitated Communication?
How common is Facilitated Communication in Australia?
Date: 4/2/2021
Reviewed: 14/12/23
Requestor: s47F - personal privacy
Endorsed by: s47F - personal privacy
Researcher: s47F - personal privacy
Cleared by: s47F - personal privacy
1. Contents
Facilitated Communication ......................................................................................................... 1
1.
Contents ....................................................................................................................... 1
2.
Summary ...................................................................................................................... 2
3.
What is Facilitated Communication? ............................................................................. 2
4.
Evidence ....................................................................................................................... 3
4.1 Clinical Guidelines ..................................................................................................... 5
5.
Facilitated Communication in Australia ......................................................................... 6
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5.1  Providers ................................................................................................................... 6
5.2  Position statements ................................................................................................... 8
6.
References ................................................................................................................... 9

2. Summary
Facilitated Communication is a communication and training technique for people with complex
communication needs. There is substantial evidence indicating that the technique is not
effective. No systematic reviews have found good quality intervention studies to support the
efficacy of Facilitated Communication. There is evidence of significant risks and harms
associated with its use. Some clinical guidelines recommend against its use and no clinical
guidelines were found allow or recommend its use.
While Facilitated Communication is widely opposed by professional groups and researchers,
some advocates still pursue research and dissemination. They often cite low quality, anecdotal
or qualitative evidence in support of Facilitated Communication.
Some services providers offer Facilitated Communication in Australia, though the extent of its
use is dif icult to determine.
RES 327 Rapid Prompting Method contains further detail on Facilitated Communication and its
relation to other communication methods that require facilitation.
3.  What is Facilitated Communication?
Facilitated Communication is technique aimed to support people with complex communication
needs to communicate in written language. A facilitator directly supports the user’s hand, arm
or shoulder to encourage the user, point to letter or type messages on a keyboard, tablet or
letterboard. It can also be used to assist users to handwrite messages with pen and paper.
The facilitator may provide emotional, communication and physical supports in the course of
the practice (Heyworth et al, 2022; Cardinal & Fulvey, 2014; Speech Pathology Australia,
2012).
Facilitated Communication has been used by both adults and children with complex
communication needs restricting their ability to communicate and participate freely and
independently in community. The method was originally developed for a person with cerebral
palsy (Tostanoski et al, 2014). However, most research focusses on autistic children or adults.
The website of the Anne McDonald Centre in Melbourne states:
Use of facilitated communication is not restricted to any specific age or any diagnostic
group. It’s been used successfully by people with diagnoses including autism, Down
syndrome, intellectual disability, cerebral palsy and acquired brain damage (Anne
McDonald Centre, n.d. c).
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Facilitated Communication is also referred to as supported typing, assisted typing or hand-
over-hand technique. The term may also be used as a generic term for different varieties of
facilitator-dependent communication tools such as Rapid Prompting Method or Spelling to
Communicate (Tostanoski et al, 2014; Speech Pathology Australia, 2012; for further
information refer to RES 327 Rapid Prompting Method). Its proponents refer to it as a form of
augmentative and alternative communication (Cardinal & Fulvey, 2014). However, critics
suggest that this is a misnomer because Facilitated Communication does not produce
independent communication (Beals, 2022).
4.  Evidence
There is a widespread consensus among professionals that Facilitated Communication is not
evidence-based and that it can lead to significant harms (Raising Children, 2022; Simmons et
al, 2021; Whitehouse et al, 2020; Steinbrenner et al, 2020). It is often assumed in the literature
that Facilitated Communication has been discredited or should be considered a
pseudoscience (Simmons et al, 2021; Steinbrenner et al, 2020; ASHA, 2018; Hemsley et al,
2018b).
Serious risks and harms associated with Facilitated Communication include:
•  violating human rights of a person with disability
•  wrongly identifying preferences of a person with complex communication needs
•  generating false statements including false al egations of abuse
•  preventing access to better communication tools or learning environments
•  encouraging more passive communication
•  cost in time and money for no improvement in communication (Raising Children,
2022; Simmons et al, 2021; ASHA, 2018; ISAAC, 2014).
From the 1990s, researchers began to assess Facilitated Communication for effectiveness
and authorship. Simmons et al describe typical controlled study methods:
The facilitator and the user are shown the same image and then asked to type the name
of the object. Invariably, the user answers correctly. Then, the facilitator and autistic
individual are shown different images, but the facilitator believes they have been shown
the same object. Invariably, the user answers incorrectly. In a particularly devastating
study run by Wheeler and colleagues with 12 individuals with autism and nine facilitators
in over 180 trials, the individual with autism did not get a single image correct (2021,
p.12).
Since this early research, high quality intervention studies consistently point to lack of efficacy:
extensive reviews have repeatedly concluded that in well-controlled experiments, the
preponderance of the evidence shows that FC messages originate from facilitators
rather than from the people who receive facilitation or from people with disabilities who
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are equally able to provide the messages without the help of the facilitator (Singer et al,
2014, p.180).
The most recent systematic review (Helmsley et al, 2018) found no intervention studies that
could establish effectiveness of Facilitated Communication or confirm that messages
generated using Facilitated Communication were primarily produced by the person with
communication needs.
Proponents respond to the evidence in a few standard ways. They argue:
•  Studies unsupportive of Facilitated Communication adopt methods which are not
designed for people with complex communication needs, especially autistic people.
•  Researchers presume the subject’s communicative incompetence and set them up
for failure.
•  Many qualitative and descriptive studies of Facilitated Communication confirm
authorship.
•  Studies using sophisticated technology such as eye tracking devices confirm
authorship.
•  Testimony of Facilitated Communication users who have progressed to independent
typing validates the technique (Heyworth et al, 2022; Chan, 2022; Cardinal & Falvey,
2014; Wilson et al, 2014).
These arguments have been largely responded to in previous studies (Beals, 2022; Simmons
et al, 2021; Helmsley et al, 2018; Singer et al, 2014; Schlosser et al, 2014; ASHA, 2018;
ISAAC, 2014).
Proponents of Facilitated Communication explain the consistent negative results in controlled
studies by suggesting artificial and stressful testing conditions cause heightened anxiety in the
subjects. In response, researchers point out that heightened anxiety does not appear to be a
problem in studies supporting Facilitated Communication authorship, even when these studies
occur in artificial situations and use novel technology such as eye tracking equipment.
Simmons et al argue that “the conditions [of controlled studies] must assuredly be less
stressful than the conditions that FC proponents often place users, such as presenting at the
United Nations or at academic conferences or even producing documentary films” (2021,
p.16).
There is a large peer reviewed literature of qualitative studies supporting the use of Facilitated
Communication. Cardinal & Fulvey (2014) point out that after the initial phase of controlled
studies, most researchers have focussed on qualitative methods. They argue this can be
explained by researchers coming to understand that qualitative methods are best suited to
investigating Facilitated Communication. Heyworth et al (2022) suggests that qualitative
studies have more explanatory power than randomly controlled trials. However, the studies
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referred to often assume the authenticity and effectiveness of Facilitated Communication and
investigate its use from the perspective of Facilitated Communication users and their family
(Beals, 2022; Simmons et al, 2021; Helmsley et al, 2018; Singer et al, 2014).
Proponents also point to the number of Facilitated Communication users who have been able
to transition to independent typing or other forms of communication (Heyworth et al, 2022;
Cardinal & Fulvey, 2015). They suggest that testimony from these former users validates the
technique. In response, Singer et al (2015) suggest that there is not enough information about
these cases to determine whether Facilitated Communication assisted the user to gain
independent communication. The presence of these cases does not rule out the possibility that
evidence-based forms of AAC or communication training could have enabled faster or more
effective communication.
4.1 Clinical Guidelines
Three guidelines were found that recommend against the use of Facilitated Communication.
No guidelines were found that recommend its use.
Speech Pathology Australia – Augmentative and Alternative Communication Clinical
Guideline
Speech Pathology Australia’s 2012 Augmentative and Alternative Communication Clinical
Guideline states that Facilitated Communication is “an approach with little supportive evidence
and a preponderance of evidence that contraindicates its use, and its use is not
recommended” (Speech Pathology Australia, 2012, p.29). The guideline also recommends:
Speech pathologists have an ethical responsibility to inform their clients and families of
the lack of supportive evidence and evidence of known harms associated with FC in the
literature, including the harms of subconscious facilitator influence and false allegations
of sexual abuse, if FC is discussed. Furthermore, speech pathologists supporting people
who use FC cannot assume that messages communicated by FC are the person’s own
messages. Speech pathologists have an ethical responsibility to: (a) assess whether the
communication is the person’s own communication or has been influenced by the
facilitator, and (b) explore all AAC system access methods (including direct and indirect
access) and strategies that allow the person to communicate independently. In keeping
with the principle that AAC includes all and multi-modal forms of communication, all of
the person’s methods of communicating must be taken into account, including extant
forms, such as, facial expression, body movements, and vocalisations (Speech
Pathology Australia, 2012, pp29-30).
The clinical guideline is no longer publicly available. Policy related to speech pathology
practice or augmentative and alternative communication no longer mentions Facilitated
Communication or its variants (Speech Pathology Australia, 2023a; 2023b; 2021).

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Autism CRC – National guideline for supporting the learning, participation, and
wellbeing of autistic children and their families in Australia
Autism CRC published the National guideline for supporting the learning, participation, and
wellbeing of autistic children and their families in Australia (National Guidelines) in 2022. It was
approved by the National Health and Medical Research Council. The National Guidelines do
not mention RPM, Facilitated Communication, Spelling to Communicate or associated
communication strategies. However, recommendation 27.4 states
Supports focussing on how the child communicates should not … Have a
communication partner use a child’s augmentative communication system (e.g.,
pictures, typing), or physically guide the child’s use of the communication system, to
convey a message on the child’s behalf (Trembath, 2022, p.66).
Scottish Intercol egiate Guidelines Network – Assessment, diagnosis and interventions
for autism spectrum disorders
Citing little evidence of effectiveness, substantial evidence that Facilitated Communication is
ineffective and significant risk of harm, the Scottish Intercollegiate Guidelines Network’s 2016
Assessment, diagnosis and interventions for autism spectrum disorders national clinical
guideline makes the following recommendations:
6.38 Facilitated communication should not be used as a means to communicate with
children and young people with ASD (p.27).
7.8 Facilitated communication should not be used as a means to communicate with
adults with ASD (p.29).
5. Facilitated Communication in Australia
Facilitated Communication is used in Australia, though its prevalence is difficult to determine.
Supports may be provided informally or training may be provided to family, carers or support
workers. Few providers were identified (refer to 6.1 Providers for details). Few organisations in
Australia openly endorse or oppose Facilitated Communication (refer to 6.2 Position
Statements for details).
Due to terminological variability, it is possible that some people are not aware they are using
Facilitated Communication. For example, a recent media release from NSW Education
Department describes the communication methods of a young autistic man, which suggest
that the man’s parents developed a form of facilitated communication independently of
established forms of the technique (Department of Education, 2022; Boynton, 2022).
5.1 Providers
Few providers were identified (refer to Table 1 Practitioners of Facilitated Communication in
Australia for the list of providers). This may be due to providers not advertising use of the
technique or describing the technique differently. Facilitated Communication may be:
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Movement and
in July 2023
Dance
(QLDFCT, 2023)
FCT Qld Inc
No
Training and
None listed.
QLD
Yes.
Workshops in
Facilitated
Communication
and other topics.
Beacon Support  Yes
Multiple services.  None listed.
QLD
Yes.
They use the
Multiple
term “facilitated  therapists.
communication”
in the context of
providing other
supports though it
is possible they
are referring to
more generic
communication
supports (Beacon
Support, n.d.).
5.2  Position statements
Reframing Autism
Reframing Autism is an Australian not-for-profit advocating for Autistic people, their families
and allies. Reframing Autism supports the use of RPM, Facilitated Communication and related
methods from a position of autistic self-advocacy:
In listening to Autistic stories, Reframing Autism acknowledges that for FC users and
their families, this method has provided a mode of communication, without which many
non-speakers would be denied a voice. FC and RPM have the potential to enable
connection with others and engagement with the world for many non-traditional
communicators (Chan, 2022).
Communication Rights Australia
Communication Rights Australia is an advocacy group for people with high communication
needs. The group has previously endorsed Facilitated Communication by publishing
testimonials of Facilitated Communication users (Chan, 2012). The group seems to be no
longer operating due to loss of funding.

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Association for Behaviour Analysis Australia
The Association for Behaviour Analysis Australia (ABAA) opposes the use of Facilitated
Communication in their 2019 position statement:
The Association of Behaviour Analysis Australia (ABA Australia) has considered the
available scientific evidence related to Facilitated Communication, Rapid Prompting
Method, and Spelling to Communicate. The scientific literature does not support the use
of these techniques. The damage caused by these techniques includes, at a minimum,
loss of opportunity for independent communication and, in some cases, extreme family
trauma (e.g., false claims of sexual abuse). These techniques have not been
demonstrated to empower communication from the person being facilitated and are not
forms of Alternative or Augmentative Communication. The official position of the ABA
Australia is that these techniques violate human rights as defined by the United Nations
Convention on the Rights of Persons with Disabilities (ABAA, 2019, p.1).
Victorian Advocacy League for Individuals with Disability
The Victorian Advocacy League for Individuals with Disability (VALID) is a Victorian based
advocacy organisation for people with intellectual disability (VALID, n.d.). VALID opposes the
use of Facilitated Communication in its 2012 position statement:
VALID does not support or endorse the use of Facilitated Communication as a form of
therapy, communications system, or as a means of making important life decisions. In
particular, communication arising from the use of Facilitated Communication should not
be used to confirm or deny accusations of abuse, neglect, or other crimes, and should
not be used to make decisions concerning guardianship or administration, treatment,
diagnosis, housing, or custody (2012, p.2).
6. References
American Speech-Language-Hearing Association. (2018). Facilitated communication [Position
Statement]. https:/ www.asha.org/policy/PS2018-00352/
Anne McDonald Centre. (n.d. a). Home. https://annemcdonaldcentre.org.au/
Anne McDonald Centre. (n.d. b). Professional Training.
https://annemcdonaldcentre.org.au/our-services/professional-training/
Anne McDonald Centre. (n.d. c). Frequently Asked Questions.
https://annemcdonaldcentre.org.au/faq/
Association of Behaviour Analysis Australia. (2019). Position Paper on Facilitated
Communication and Rapid Prompting Method.
https://auaba.com.au/resources/Documents/Position%20Paper%20FC%20RPM ABA%
20Australia.pdf
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Beacon Support. (n.d.). Facilitated Communication. https://www.beaconsupport.com.au/ndis-
service-provider/facilited-communication-in-home-care/
Beals, K. (2022). Why we should not presume competence and reframe facilitated
communication: a critique of Heyworth, Chan & Lawson. Evidence-Based
Communication Assessment and Intervention, 2(16), 66–76,
https://doi.org/10.1080/17489539.2022.2097872
Boyton, J. (2022). NSW Teachers and FC – too much of a helping hand? Facilitated
Communication: a thoroughly discredited but persistent practice.
https://www.facilitatedcommunication.org/blog/nsw-teachers-and-fc-too-much-of-a-
helping-hand
Cardinal, D. N., & Falvey, M. A. (2014). The Maturing of Facilitated Communication: A Means
Toward Independent Communication. Research and Practice for Persons with Severe
Disabilities, 39(3), 189-194. https://doi.org/10.1177/1540796914555581
Chan, T. (2022). Position Statement on Autistic Communication. Reframing Autism.
https://reframingautism.org.au/position-statement-on-autistic-communication/
Chan, T. (2012). My Experience With AAC. Communication Rights Australia.
https://www.communicationrights.org.au/education/my-experience-with-aac-tim-chan-
2012/
Department of Education. (2022). Charlie emerges as an advocate from a cocoon of silence.
Government of New South Wales. https://education.nsw.gov.au/news/latest-
news/charlie-emerges-as-an-advocate-from-a-cocoon-of-silence
Hemsley, B., Bryant, L., Schlosser, R.W., Shane, H.C., Lang, R., Paul, D., Banajee, M., &
Ireland, M. (2018a). 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.
https://doi.org/10.1177/2396941518821570
Hemsley, B., Shane, H.C., Todd, J., Schlosser, R.W. & Lang, R. (2018b). It's time to stop
exposing people to the dangers of Facilitated Communication. The Conversation.
https://theconversation.com/its-time-to-stop-exposing-people-to-the-dangers-of-
facilitated-communication-95942
International Society of Augmentative and Alternative Communication. (2014). ISAAC Position
Statement on Facilitated Communication. Augmentative and Alternative
Communication, 30(4), 357-358. https://doi.org/10.3109/07434618.2014.971492
Queensland Facilitated Communication Training Inc. (2023). Understanding Sensory
Movement Difference and Diversity in Autism. https://qldfctinc.square.site/product/alice-
owen-workshop-support-workers-service-providers/3?cs=true&cst=custom
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Schlosser, R., Balandin, S., Hemsley, B., Iacono, T., Probst, P., & von Tetzchner, S. (2014).
Facilitated communication and authorship: A systematic review. Augmentative and
Alternative Communication, 30, 359–368.
Scottish Intercollegiate Guidelines Network. (2016). Assessment, diagnosis and interventions
for autism spectrum disorders [SIGN 145]. Edinburgh: SIGN.
https://www.sign.ac.uk/media/1081/sign145.pdf
Simmons, W.P., Boynton, J., & Landman, T. (2021). Facilitated Communication,
Neurodiversity, and Human Rights. Human Rights Quarterly, 43(1), 138-167.
https://doi.org/10.1353/hrq.2021.0005
Singer, G. H. S., Horner, R. H., Dunlap, G., & Wang, M. (2014). Standards of Proof: TASH,
Facilitated Communication, and the Science-Based Practices Movement. Research and
Practice for Persons with Severe Disabilities, 39(3), 178-188.
https://doi.org/10.1177/1540796914558831
Speech Pathology Australia. (2023a). Augmentative and Alternative Communication.
https://www.speechpathologyaustralia.org.au/Public/Public/Comm-swallow/Aug-alt-
strategies/Augmentative-Alternative-Communication.aspx?hkey=b6dd3db5-465d-46a2-
94e0-c6b3a4c69de8
Speech Pathology Australia. (2023b). Scope of Practice.
https://www.speechpathologyaustralia.org.au/Public/Public/About-Us/Ethics-and-
standards/Scope-of-Practice.aspx?hkey=6e4daa08-aa40-4489-aede-f2faf685b4ef
Speech Pathology Australia. (2021). Evidence-based practice for speech pathology in
Australia. https://acdhs.edu.au/wp-
content/uploads/2021/07/EBP speechpathologyinaustralia 16062021-3.pdf
Speech Pathology Australia. (2012). Augmentative and Alternative Communication Clinical
Guideline. Melbourne: Speech Pathology Australia.
Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowel , S. W., Tomaszewski, B.,
Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-
based practices for children, youth, and young adults with Autism. The University of
North Carolina at Chapel Hil , Frank Porter Graham Child Development Institute,
National Clearinghouse on Autism Evidence and Practice Review Team.
Tostanoski, A., Lang, R., Raulston, T., Carnett, A., & Davis, T. (2014). Voices from the past:
Comparing the rapid prompting method and facilitated communication. Developmental
Neurorehabilitation, 17(4), 219-223.
Trembath, D., Varcin, K., Waddington, H., Sulek, R., Pil ar, S., Al en, G., Annear, K., Eapen,
V., Feary, J., Goodal , E., Pilbeam, T., Rose, F., Sadka, N., Silove, N., Whitehouse, A.
(2022). National guideline for supporting the learning, participation, and wellbeing of
autistic children and their families in Australia. Autism CRC. Brisbane.
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Victorian Advocacy League for Individuals with Disability. (2012). Position statement on the
use of Facilitated Communication.
http://www.valid.org.au/FCPosition/fc position statement.pdf
Whitehouse, A., Varcin, K., Waddington, H., Sulek, R., Bent, C., Ashburner, J., Eapen, V.,
Goodall, E., Hudry, K., Roberts, J., Silove, N., Trembath, D. (2020). Interventions for
children on the autism spectrum: A synthesis of research evidence. Autism CRC,
Brisbane.
Wilson, M., de Jonge, D., de Souza, N., & Carlson, G. (2014). Facilitated communication
training: Exploration of perceptions of ability and reducing physical support. Disability
Studies Quarterly, 34(1).
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DOCUMENT 9
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What is ACC?
Augmentative and Alternative Communication (AAC) interventions use and/or teach the use of a
system of communication that is not verbal/vocal.
There are two types of AAC systems – aided and unaided
Unaided systems
These AAC systems don’t need any equipment. They use gestures and hand signs – for example, Key
Word Sign – to support speech, or as the main way of communicating.
Aided systems
These AAC systems can be low-tech or high-tech.
Low-tech systems use equipment like cards, boards or books with photos or pictures that represent
tasks, actions or objects. These tools can be used to understand what people are saying, ask for what
they need, make comments and answer other people’s questions. Picture Exchange Communication
System (PECS) and visual timetables are examples of this kind of system.
High-tech systems include speech-generating devices (SGDs). Also, many apps have been designed
for use with iPads and Android devices to help with the development of communication skills.
Autism CRC findings on AAC
3 systematic reviews [1-3] at the practice level. The report findings suggested that the general
outcomes of AAC for autism has an ‘emerging level of evidence’. In contrast, facilitated
communication was identified as having an ‘unestablished level of evidence' and a ‘null effect’.
Core Autism characteristics
• Social communication = Low to moderate quality with inconsistent therapeutic effect
Related skil s and development
• Communication = Low quality, positive effect
• Motor = Low quality, positive effect
• Social emotional/challenging behaviour = Low quality, positive effect
• Play = Low quality, positive effect
• General outcomes = Low quality, inconsistent therapeutic effect
Education and participation
• Academic skills = Low quality, positive effect
Family wellbeing
• Caregiver satisfaction = Moderate quality, inconsistent therapeutic effect
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Attitude toward using high-tech AAC - reported
that voiceless patients felt quite satisfied with
and adapted to high-tech AAC during their ICU
stay. >90% of patients were interested in
continuing to use the high tech AAC.

Patient factors - The patients’ cognitive state
and level of sedation had a huge impact on
communication. Deterioration/fluctuation status
caused fatigue, difficulty concentrating, memory
loss and poor motor-control skil s among
patients, which also made the use of high-tech
AAC harder or even impossible
Light,

McNaughton
[5]
Barbosa, de
To investigate the
Systematic Review
13 included studies

Oliveira [6]
results presented in
previous studies on
Inclusion criteria

AAC use in children with
Down Syndrome (DS)
Studies published in English were
observing the different
eligible if they met the fol owing
instruments used for
criteria: (1) study of children with a
communication
diagnosis of DS, and (2) assistive
technology and/or AAC analysis in this
population. There were no restrictions
regarding sample size, time of
publication or the type of study design.

PEDro scale used to determine study
quality

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1.
Logan K, Iacono T, Trembath D. A systematic review of research into aided AAC to increase
social-communication functions in children with autism spectrum disorder. Augmentative and
Alternative Communication. 2017;33(1):51-64.
2.
Steinbrenner J, Hume K, Odom S, Morin K, Nowel S, Tomaszewski B, et al. Evidence-Based
Practices for Children, Youth, and Young Adults with Autism. 2020. Available from:
https://fpg.unc.edu/publications/evidence-based-practices-children-youth-and-young-adults-
autism-spectrum-disorder-1.

3.
National Autism Center. Findings and conclusions: National standards project, phase 2.
Author Randolph, MA; 2015. Available from: https://www.nationalautismcenter.org/national-
standards-project/phase-2/.

4.
Ju X-X, Yang J, Liu X-X. A systematic review on voiceless patients’ wil ingness to adopt high-
technology augmentative and alternative communication in intensive care units. Intensive and
Critical Care Nursing [Internet]. 2020 2020/11/07/:[102948 p.]. Available from:
http://www.sciencedirect.com/science/article/pi /S0964339720301518.
5.
Light J, McNaughton D, Caron J. New and emerging AAC technology supports for children
with complex communication needs and their communication partners: State of the science and
future research directions. Augmentative and Alternative Communication [Internet]. 2019
2019/01/02; 35(1):[26-41 pp.]. Available from: https://doi.org/10.1080/07434618.2018.1557251.
6.
Barbosa RTdA, de Oliveira ASB, de Lima Antão JYF, Crocetta TB, Guarnieri R, Antunes TPC, et
al. Augmentative and alternative communication in children with Down’s syndrome: a systematic
review. BMC Pediatrics [Internet]. 2018 2018/05/11; 18(1):[160 p.]. Available from:
https://doi.org/10.1186/s12887-018-1144-5.

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DOCUMENT 10
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Research Request- Facilitated Communication
Literature update
Brief
FC document has progressed to Q&S to develop an agency position. Previous
research conducted 18 months ago. Updated literature search required.
Date
20/01/21
Requester(s)
Jane

s47F - personal (Assistant Director – TAB)
Researcher
Jane s47F - personal priv (Research Team Leader)
Cleared
Contents
Facilitated Communication ................................................................................................................. 1
1. Search strategy ........................................................................................................................... 2
1.1
Search string ........................................................................................................................ 2
1.2
Limiters ................................................................................................................................ 2
1.3
Databases: ........................................................................................................................... 3
1.4
Data extraction.................................................................................................................... 3
1.5
Number of references: ........................................................................................................ 3
2. Findings ....................................................................................................................................... 5
Table 1: General study information ................................................................................................ 5
Table 2. Methods and Characteristics of included studies ............................................................. 7
Table 3. Results/author conclusions ............................................................................................. 11
Table 4. Quality assessment checklists/quality of evidence ......................................................... 15
3. Summary ................................................................................................................................... 16
4. References ................................................................................................................................ 17
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This literature search and summary of evidence was conducted by Dr Jane Scheetz (Research Team
Leader – Technical Advisory Branch). In an academic setting the paper selection process is conducted
by two reviewers independently of each other (known as double screening). This approach is
resource intensive, however, has been shown to lead to less studies being missing. Whilst single
screening is not equivalent to double screening, it is still considered an appropriate methodological
approach in rapid reviews, as long as it is conducted by an experienced reviewer.
The program COVIDENCE was used to screen and assess studies for inclusion. Data were extracted
and quality assessments made within the COVIDENCE application. The Critical Appraisal Skills
Checklist (CASP) and the Joanna Briggs Institute (JBI) quality assessment tools were used to assess
the trustworthiness, relevance and results of included studies.

1.  Search strategy
1.1  Search string
Since Facilitated Communication is typically not a keyword indexed in the thesaurus of most
databases, I chose to use the following terms as free-text phrases:
“Facilitated communication” OR “assisted typing” OR “supported typing”
AND
disabil* OR  "people with disabil*" OR pwd  OR  "disabled people" OR disabilit* OR  "people with
disabilit*" OR “intellectual disabil*"  OR autis* OR “autism spectrum disorder*” OR ASD OR
“communication disorder*” OR “speech disorder*” OR “cerebral palsy”
Search terms such as ‘disability’, ‘autism spectrum disorder’ and ‘cerebral palsy’ were utilised to
narrow the search results. These terms were chosen as facilitated communication is commonly
utilised as an intervention in participants with these conditions.

1.2  Limiters
Type of publication: peer reviewed article
Year of publication: no restriction
Language: English
Publication type: Systematic review, meta-analysis, review or narrative synthesis
A systematic review of al  published FC literature was published in 2018, therefore, the above search
was re-run from 2017- onwards with no limitation on publication type. This was to enable us to
identify any new research published since the last systematic review.

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1.3  Databases:
The following databases were searched: CINHAL, PsycInfo, Cochrane, Medline, Scopus and ProQuest.

1.4  Data extraction
Data was extracted for Author/s, Year, Title, Country, Study type, Aim, Search strategy, Inclusion
criteria, population description, Total number of participants, Funding/conflict of interest, other
methodological details, Summary of results, Risks/limitations, Author conclusions .

1.5  Number of references
Refer to PRISMA flow diagram.
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Figure 1: PRISMA flow diagram.
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2. Findings
Table 1: General study information
Study
Title
Country
Study Type
Aim of study
A History of Facilitated Communication:
United
Literature
Science, Pseudoscience, and Antiscience
States
Review
Jacobson, Mulick [1]
Science Working Group on Facilitated
(1995)
Communication
To attempt to identify a scientific history of FC
Australia
Systematic
Systematic review of facilitated
Review
communication 2014 to 2018 finds no new
This study aimed to conduct a systematic review of the
evidence that messages delivered using
literature on FC published between 2014 and 2018 to inform
Hemsley, Bryant [2]
facilitated communication are authored by the
the 2018 update of the 1995 American Speech-Language-
(2018)
person with disability
Hearing Association Position Statement on FC.
United
Systematic
States
Review
Facilitated communication and its legitimacy-
The purpose of this article is to provide an updated review on
Mostert [3] (2010)
twenty-first century developments.
the status of research on FC efficacy since 2001
United
Case study
To preliminarily assess a novel approach for assessing FC
States
based on the logic that if the participant could not recognize
Evaluation of word recognition fol owing
typed words, then this pattern would suggest that any
Roane, Kadey [4]
typing produced through facilitated
previously typed communication was not of her own
(2019)
communication.
production
Assessing 'alternative' therapies for
United
Literature
communication disorders in children with
States
Review
autistic spectrum disorders: facilitated
To help speech-language clinicians and audiologists assess the
Siegel and Zimnitzky [5] communication and auditory integration
validity and utility of FC methods based on research that has
(1998)
training.
been conducted.
Finland
Systematic
Aim: To review linguistic studies claiming to validate FC
Review

Questions
Does Linguistic Analysis Confirm the Validity of
Research Question 1: What is the role given to message-
Salovi ta [6] (2018)
Facilitated Communication?
passing tests in these studies?
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Research Question 2: Do the studies abide by the
methodological recommendations made by the ICI on the
correct use of FC (ICI, 2010, 2012)?
Research Question 3: How is the linguistic argument
developed in these studies? Does the argumentation surpass
the trap of logical circularity discussed above?
Schlosser, Balandin [7] Facilitated communication and authorship: a
United
Systematic
To examine and synthesize the research evidence on who is
(2014)
systematic review.
States
Review
authoring the messages generated through FC
United
Systematic
Aim: To synthesize FC studies appearing in the empirical
States
review
literature since the last major reviews by Jacobson et al.,
(1995) and Simpson and Myles (1995).

Questions
1. What are the characteristics of the FC studies published
since 1995?
2. Overal , what is the nature of the evidence in these studies
related to FC efficacy?
Facilitated communication since 1995: a
3. How legitimate are the claims of two studies using control
Mostert [8] (2001)
review of published studies.
procedures and claiming substantial evidence of FC efficacy?

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Table 2. Methods and Characteristics of included studies
Study
Search strategy
Inclusion
Population description
Funding/con Other methodological details
criteria
Total number of
flict of

participants
interest
Jacobson,
Not reported
Any study type   The studies reviewed
126 across 15
Not
Most studies used repeated measures under
Mulick [1]
which
covered autism, cerebral
studies. Only 4
reported
different conditions with facilitator-participant
(1995)
investigated
palsy, or epilepsy in
(3.1%) participants
pairs as their own controls.
FC, published
combination intel ectual
demonstrated
in peer
disability (moderate, severe  accurate
reviewed
or profound).
communication
journal
under blind

conditions.
Hemsley,
Electronic
Any study type  No reported
18 included studies  Not
Papers divided into levels Level 1: Quantitative
Bryant [2]
database search,
relating
reported
experimental studies (or systematic reviews of
(2018)
ancestry searches
directly to FC
such studies) involved an a priori control ed
of bibliographies
and published
manipulation of knowledge/stimuli presented
in peer-
to the facilitator and FC used by the individual
reviewed
in an attempt to empirical y establish who was
literature and
in English
authoring the messages produced in response
to the stimuli. Level 2: Studies and reviews that
included quantitative descriptive data on the
output generated through the process of FC
without a priori testing of authorship (i.e.
without empirical manipulation related to
authorship). Level 3: Qualitative descriptive
data on the output generated through the
process of FC without pretesting of authorship,
and qualitative research methods such as
participant observations and interviews. Level
4: Anecdotal reports

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Mostert [3]  Electronic
Any study type  Mix of participants with
3 included studies.
Not
Single author performed al  screening and data
(2010)
database search,
published in a
autism, cerebral palsy,
Two claiming FC
reported
extraction.
manual search of
peer-reviewed  Down syndrome,
efficacy and one
most widely read
journal, studies  severe/profound learning
refuting. Unclear
special education
be in English
disabilities, and complex
how many
journals also
and published
communication problem.
participants
performed
between 1999
Most participants were
involved.
and 2008.
chosen because they did
not refuse to participate.
The study with control ed
experiments included
participants without a
disability.
Roane,
N/A
N/A case study  -9-year-old girl diagnosed
1
Not
-Materials: 25 words that the participant most
Kadey [4]
with ASD and severe
reported
commonly typed during previous FC sessions
(2019)
intel ectual disability.
were identified. During experiments, text was
-No speech, communicated
presented at 40-pt black font on white backing
by idiosyncratic gestures,
across conditions.
and was not toilet trained.
-Procedures Seven conditions were examined
-Communicated daily at
within a multi-element design. With the
school via FC. Her school-
exception of the match-to-sample (MTS)
based FC sessions were
condition, each session consisted of 25 trials in
always conducted with a
which each target was presented once in a
specific speech therapist.
random order. Two or three sessions were
-FC sessions conducted 5
conducted for each condition. Across al
days per week,
conditions, a vocal prompt (and when
approximately 45 min per
appropriate, the cue; described below) to
day. Two to four sessions
identify a target or answer a question about
were conducted daily. All
the target was presented once every 30 s
sessions were conducted in
a self-contained room (8 m
by 10 m) that contained
chairs, a table, and other
materials depending on the
condition in effect.
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Siegel and
Not reported
Not reported
Not reported
Not reported
Not

Zimnitzky
reported
[5]
(1998)
Salovi ta
Electronic
FC validated
6 studies with autism, 1
9 included studies
None
Facilitation type not regularly reported across
[6] (2018)
database search,
using linguistic  cerebral palsy and 1
(n = 68). 4/9 studies
included studies. Eye contact and fading
hand searches and  analysis of the
intel ectual disability. Aged
were single case
described in 1/9 studies.
manual search of
text samples
3-32.
design.
specific disability
(any study
and
type),

communication
published in a
journals
peer-reviewed
journal or an
edited book.
Schlosser,
Electronic
Any study type  Not reported
Level 1: 27 studies
None
Checklist developed to provide means of
Balandin
database search,
relating
considered in this
classifying documents. This included FC
[7] (2014)
ancestry searches
directly to FC
review included
(Yes/No), peer reviewed (Yes/No). Their level of
and contacting
and published
both blinded and
inclusion (i.e., quantitative, qualitative,
individual authors
in peer-
non-blinded
experimental, descriptive, or anecdotal data).
reviewed
conditions. Level 2:
Documents were then classified into Level 1
literature and
11 studies
(quantitative experimental data), 2
in English
Level 3: 7 studies
(quantitative descriptive da), 3 (qualitative
Level 4: 24
descriptive data) & 4 (anecdotal reports). All
documents
docs coded by 2 authors.
Mostert [8]  Electronic
Any study type  Studies divided into Control  Unclear. Some
Not
While literature reviews often exclude
(2001)
database search,
published in a
procedures (CP) (+ and -)
studies didn’t
reported
published studies which are methodological y
hand searches and  peer reviewed
and No control procedures
consistently report
unsound, such studies were included here
manual search of
journal.
(NCP).
the number.
because a central issue in evaluating the
specific disability
Excluded if the

efficacy of FC revolves around proponents’ use
and
study
Autism and intel ectual
CP- = range 1-32
of methodological y suspect means to claim FC
communication
participants
disability, were most often
CP+ = range 1-43
as a successful intervention.
journals
were
represented across al  study  NCP+ = range 1-17

facilitators and  types.
Communication medium: almost al  the studies
not clients
Age and sex: Not always
used typing by the subjects with direct or
provided. Where sex was
indirect physical support by their facilitators
specified, subjects were

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predominantly male. The
Duration: Highly variable, for example, 4 days
subjects’ overal age range
per week for 14 weeks compared to 3
was 6–52 years.
consecutive days

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Table 3. Results/author conclusions
Study
Summary of results
Risks/limitations  Author conclusions
Jacobson, Mulick
Level 1 or 2: No studies located. As such, no new research since
Lower level
No new studies on authorship and therefore no
[1] (1995)
2014 was found that is suitable for evaluating authorship in FC.
studies were not
evidence that FC is a valid form of
Level 3: Three studies were included and were based on messages  further analysed
communication for individuals with severe
produced during interviews with people who use FC, al  of which
and subjected to
communication disabilities. Given that facilitator
are supportive of FC. The results of these studies were not further  quality review.
control has been documented repeatedly and
analysed as the authors of these studies ‘‘failed to pre-establish
Gives no insight
replicated by several different research teams
authorship by their participants’ .
into the
across continents over the last 26 years, it is not
Level 4: 15 papers included. Because these reports were
methodological
surprising to see that there are no additional
anecdotal, they cannot be considered as scientific evidence
limitations and
studies addressing the question of authorship in
regardless of whether the opinions expressed supported or
findings of these
FC.
refuted authorship by the individual with a communication
studies.
disability.
There is a substantial growth of peer-reviewed literature that is
critical of FC and warns against its use (n = 14) and scant peer-
reviewed literature that is supportive of FC (n =1).
Hemsley, Bryant
The findings of control ed, as opposed to qualitative studies have
No search
Control ed research using single and double blind
[2] (2018)
been consistently negative, indicating that FC is neither reliably
methods. A
procedures in laboratory and natural settings
replicable nor valid when produced. Relevant control ed, peer
literature review
with a range of clinical populations with which FC
reviewed, published studies repeatedly show that, under
of selected
is used have determined that, not only are the
circumstances when access to information by facilitators is
articles. This can
people with disabilities unable to respond
systematical y and tightly manipulated, the ability to produce
introduce
accurately to label or describe stimuli unseen by
communication through FC varies predictably and in a manner
significant bias as
their assistants, but that the responses are
that demonstrates that the content of the communication is
it is unclear what
control ed by the assistants.
being determined by the facilitator. Demonstrations of benefit
was not included
are based on anecdotes or testimonials; baseline abilities and the  for review.
possibility of spontaneous improvement are ignored, and related
scientific procedures are rejected; and therapists who use FC
unsuccessfully are blamed for not doing it correctly or not
believing that it wil  work. Instead of control ed situations,
proponents of FC suggest that qualitative criteria for validity
should be used. Many of these criteria are not falsifiable, and al
are easily contaminated by clinician or researcher expectations or
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knowledge gained through social interactions and review of
records in the work settings.
Mostert [3] (2010)  The two un-control ed studies were said to have produced false
Literature review.  FC is one of the best exemplars of how practice
and misleading understandings of FC. Techniques included un-
Single author,
can become absolutely dissociated from
control ed transcriptions of FC interactions in everyday settings.
could be seen as
empirical research.
Various biases were pointed out including participant consent,
publication bias.
participants were able to practice tests before attempting with a
facilitator. Furthermore, only a smal  number of participants
achieved above chance levels on the facilitation task, however,
this was presented as being effective.

The only control ed study performed 5 experiments. Al  showing
that communication is the function of the facilitator and not the
client. These were moderately sized experiments. Several were
designed to “see if they could ‘read the muscle movements’ of a
normal participant”.
Roane, Kadey [4]
Correct responding occurred at chance levels (i.e., approximately
Single subject
The current results are preliminary and, although
(2019)
50% with expected deviations around that mean; ranging from an  design
we attempted to control for various FC
average of 36% in the Yes/No condition to an average of 63% in
procedures (e.g., providing encouragement via
the 2-options with cue condition). In general, there was no
attention delivery), we did not provide physical
evidence that the participant could correctly identify the various
support when the participant was given the
features of words that she produced during 53 days of FC
opportunity to type; thus, we were not
sessions at school.
implementing FC

Siegel and
Research studies have very consistently invalidated various
No search
The miracles promised by FC are unsupported.
Zimnitzky [5]
assumptions underlying FC by empirical y testing various extant
methods. A
(1998)
assumptions. These studies clearly showed that the FC messages
literature review
originated from the facilitator and not the participant. Most
of selected
studies indicating positive results of FC lack methodological rigor
articles. This can
and are published as case reports in non-peer reviewed settings.
introduce
In summary, FC has no established validity.
significant bias as
it is unclear what
was not included
for review.
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Salovi ta [6]
-Three studies contained no formal comparison material to check  No methods for
1.  No attention was paid to the reporting
(2018)
the supposed uniqueness of the texts produced. The remaining
data extraction
of possible message-passing tests in
six studies applied some form of statistical analysis to support
reported
these studies. Experimental control was
their conclusions.
not considered essential.
-Researchers regularly concluded that peculiarities found within
2.  Studies usual y did not fol ow the
writing performed using FC supported the authenticity of the
recommendations of the FC field on the
communication. Their reasoning was that facilitators would not
proper use of FC.
use these terms in their everyday writing.
3.  No independent information on the
-There are several recommendations relating to qualification for
participants’ personal writing styles was
FC intervention (limited speech, an inability to perform
given; consequently, the claim for true
autonomous pointing), eye contact and fading. Al  the reviewed
authorship remained unsupported.
linguistic validation studies failed to confirm that their

participants qualified for FC. It also remains unclear whether the
In summary, the linguistic studies reviewed here
studies, with one exception, fol owed the norms concerning eye
have not produced any support for the claims of
contact and fading.
FC’s validity. The idiosyncratic features of the
- Studies have shown that the texts produced via FC are different
texts produced via FC are more easily explained
when a comparison is made with the standard users of the
as artefacts of the writing process itself.
language, or with the facilitators’ own writings. The authors
Accordingly, there is no need to resort to the
consider these differences either as strong proof of the validity of
miraculous explanations provided by FC
FC, however, no independent evidence was reported in any
supporters.
study of the supposedly unique communication style of the
participants
Schlosser,
Level 1: Included reviews and individual studies concluded that
Lower level
Four levels of analysis were used in this review,
Balandin [7]
there was overwhelming evidence for facilitator control in FC.
studies were not
although only literature that met level one
(2014)
Level 2: In-depth analyses of these studies was not warranted
further analysed
criteria was deemed to provide scientific
because it was evident that the authors of these studies failed to
and subjected to
evidence of authorship of communicative
pre-establish authorship by their participants.
quality review.
messages. Three systematic reviews and four
Level 3: This evidence provides descriptive qualitative data
Gives no insight
individual studies met level one criteria and this
regarding the output generated by individuals using FC. The same  into the
literature provided robust evidence that FC is
conclusions apply as for level two evidence.
methodological
not a valid technique.
Level 4: Because anecdotal reports were essential y perspectives
limitations and
of individuals, they could not be accepted as scientific evidence
findings of these
(a) supporting a demonstration of authorship, or (b) refuting a
studies.
demonstration of authorship. Therefore, for the purposes of this

review, a more in-depth analyses of these perspectives was not
No overview/data
warranted.
extraction
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presented for
Level 1 studies.
Descriptive
summary provided
instead.
Mostert [8] (2001)  The results of the review support and confirm the conclusions
No second
In summary, FC proponents must be encouraged
reached by previous reviewers of the empirical FC literature - FC
examiner to check  to subject their claims to further scientific
is not valid and the facilitator influences the communication
validity of
verification, the claims of anecdotal evidence
produced by the subject. The divide between the results of
included studies
notwithstanding. If any smal  part of FC is to ever
studies incorporating control procedures find very little to no
and extract data.
be found effective or even plausible, it is
support for the efficacy of FC, studies employing fewer control
abundantly clear that only by careful use of
procedures produce mixed results, and studies ignoring control
control ed experimental methods wil  this be
procedures almost universal y find FC to be effective. In the cases
established.
of the few, tentative positive results emerging from studies
reporting some form of control procedures, as in the cases of
Cardinal et al. (1996) and Weiss et al. (1996), these results are
much more likely the artefact of methodological problems than
an accurate representation of persuasive evidence.

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Table 4. Quality assessment checklists/quality of evidence
CASP
Did the
Did the authors  Do you think all  Did the
If the results  How precise
Can the
Were all
Are the  Quality
Systematic
review
look for the
the important,
reviewer’s
of the review  are the results?  results be
important
benefits  of
Review
address a
right types of
relevant studies  authors do
have been

applied to
outcomes
worth
evidence
(Yes/No/Can’ clearly
papers?
were included?
enough to
combined,
No studies
the local
considered
the
(GRADE)
t tell)
focused
assess the
was it
provided
population?  ?
harm

question?
quality of
reasonable
statistics
and

the included  to do so?
related to
costs?
studies?
precision
(confidence
interval etc.)
Jacobson,
Can’t tel
Yes
Can’t tel
Can’t tel
Yes
N/A
Can't tell
Can't tell
No
s47C - deliberative
pro
Mulick [1]
Hemsley,
Yes
Yes
Yes
Yes
Yes
N/A
Can't tell
Yes
No
s47C - de

Bryant [2]
Mostert [3]
Yes
Yes
Yes
Can’t tel
Yes
N/A
Can't tell
Can't tell
No
s47C - deliberative
pro
Siegel and
Yes
Can’t tel
Can’t tel
Yes
Yes
N/A
Can't tell
Can't tell
No
s47C - deliberative
pro
Zimnitzky [5]
Salovi ta [6]
Yes
Yes
Yes
Can’t tel
Yes
N/A
Yes
Yes
No
s47C - de

Schlosser,
Yes
Yes
Yes
Yes
Yes
N/A
Can't tell
Yes
No
s47C - de

Balandin [7]
Mostert [8]
Yes
Yes
Yes
Yes
Yes
N/A
Yes
Yes
No
s47C - de

JBI Checklist
Were
Was the
Was the current  Were
Was the
Was the post-
Were
Does the

Case Control
patient’s
patient’s
clinical
diagnostic
intervention  intervention
adverse
case report
(Yes/No/
demographic  history clearly
condition of the  tests or
or treatment  clinical
events
provide
Unclear/NA)
characteristic described and
patient on
assessment
procedure
condition
(harms) or
takeaway
s clearly
presented as a  presentation
methods and  clearly
clearly
unanticipat lessons?
described?
timeline?
clearly
the results
described?
described?
ed events
described?
clearly
identified
described?
and
described?
Roane, Kadey  Yes
Yes
Yes
Yes
Yes
No
No
Yes

s47C - deliberative   p
[4]

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3.  Summary
Peer reviewed evidence investigating the validity of facilitated communication is of low to very low
quality. Systematic and narrative reviews on the topic include studies considered to represent low
levels of evidence (based on the NHMRC evidence hierarchy) and the synthesis of the data extracted
from included studies is poorly reported.
Experimental studies on FC are either Level II -2 (Non-randomised, experimental trial, Cohort study,
Case-control study) Level II -3 (Historical control study, Two or more single arm study, Interrupted
time series without a parallel control group) or Level IV (case series). These types of studies are often
utilised when a new intervention is being investigating initially, however, they are more prone to
bias which can impact on the efficacy of results compared to a pseudo randomised or randomised
controlled trial (RCT). There are no RCT’s which investigate FC or compare it to another best practice
intervention.
The main area of dispute around FC is whether people with a disability are being facilitated to
express their own communicative intentions, or whether the source of the output is that of the
facilitator (termed authorship). All literature included in this review came to the same basic
conclusion –
1)  FC is not valid and the facilitator influences the communication produced by the subject
2)  Results of studies incorporating control procedures find very little to no support for the
efficacy of FC
a.  studies employing fewer control procedures produce mixed results
b.  studies ignoring control procedures almost universally find FC to be effective
Reports of positive results following the use of FC (unexpected language and literacy abilities) tend
to have been derived from uncontrol ed or poorly control ed case studies and published in non-peer
reviewed journals/websites. FC proponents have essentially supplied detailed but only anecdotal
descriptions of what individuals have been helped to say through FC.
Rather than seeking conventional validation for the technique, FC proponents have tended to avoid
normal experimental methods and scientific investigation on the grounds that the imposition of an
experimental design destroys the participant’s trust upon which their desire to communicate is
based.

“Facilitated communication is one of the best exemplars of how practice can become absolutely
dissociated from empirical research.” Mostert [3]

At this time, all credible evidence is against the use of FC. Proponents of the technique must subject
their claims to further scientific verification through the use of carefully controlled experimental
methods before making claims of success.

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4. References
1.
Jacobson JW, Mulick JA, Schwartz AA. A History of Facilitated Communication: Science,
Pseudoscience, and Antiscience Science Working Group on Facilitated Communication. The
American psychologist. 1995;50(9):750-65.
2.
Hemsley B, Bryant L, Schlosser RW, Shane HC, Lang R, Paul D, et al. 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. 2018;3:2396941518821570.
3.
Mostert MP. Facilitated communication and its legitimacy-twenty-first century
developments. Exceptionality. 2010;18(1):31-41.
4.
Roane HS, Kadey HJ, Sul ivan WE. Evaluation of word recognition fol owing typing produced
through facilitated communication. Journal of Applied Behavior Analysis. 2019;52(4):1107-12.
5.
Siegel B, Zimnitzky B. Assessing 'alternative' therapies for communication disorders in
children with autistic spectrum disorders: facilitated communication and auditory integration
training. Journal of Speech-Language Pathology & Audiology. 1998;22(2):61-73.
6.
Saloviita T. Does Linguistic Analysis Confirm the Validity of Facilitated Communication? Focus
on Autism & Other Developmental Disabilities. 2018;33(2):91-9.
7.
Schlosser RW, Balandin S, Hemsley B, Iacono T, Probst P, von Tetzchner S. Facilitated
communication and authorship: A systematic review. AAC: Augmentative and Alternative
Communication. 2014;30(4):359-68.
8.
Mostert MP. Facilitated communication since 1995: a review of published studies. J Autism
Dev Disord. 2001;31(3):287-313.
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