What Is Facilitated Communication?

Medically Reviewed by Mahammad Juber, MD on October 14, 2022
4 min read

What is facilitated communication?

Facilitated communication is a form of alternative communication developed to help individuals with severe autism or other individuals who cannot express their thoughts and feelings vocally. Facilitated communication is also known as supported typing. 

Facilitated communication has been around since the 1970s and was first developed in Australia and Denmark. Initially, this therapy was created to help individuals with cerebral palsy. Australia then became the first country where facilitated communication was used in therapies to treat autism. 

Facilitated communication requires a facilitator who supports the disabled individual emotionally and physically and examines posture and eye contact. Facilitators’ roles are limited, and they generally provide only the bare minimum of support, such as a light touch when guiding their patient’s hand. In some cases, though, more support is needed, and the facilitator will support a disabled individual’s hand or arm while they use some form of technology to communicate, such as a computer keyboard, smartphone, or a more specialized device.

One facilitated communication example could be a facilitator who guides a disabled individual when the latter is typing words on a keyboard or letter board. Typically, the facilitator helps the individual close their hand, forming a fist, with their index finger (the finger most commonly used to spell out the words) extended. The facilitator supports the patient’s arm, elbow, or hand and guides the hand toward the keyboard. 

The facilitator provides encouragement while the patient continues spelling out their thought. 

Facilitated communication may seem to have many advantages. The main benefit is that facilitated communication allows non-verbal individuals to express themselves. Other benefits include: 

  • Patients being able to write complete and intelligible sentences 
  • Patients being able to communicate with their peers
  • Patients being able to answer questions about their desires 
  • Patients receiving help in developing motor skills 

Despite some benefits, there is significant risk associated with using facilitated communication, and these risks outweigh any supposed benefits. 

Many individuals fear using facilitated communication because they do not want their loved ones to rely on this type of communication. Many organizations similarly recommend avoiding facilitated communication methods. 

Disadvantages to facilitated communication include: 

  • A lack of evidence in support of facilitated communication improving independent communication skills 
  • Some individuals who have developed independent communication skills may be stunted into passive communicators. 
  • Evidence points to facilitators unconsciously writing messages on behalf of their patients. 
  • When a facilitator unconsciously writes a more sophisticated or advanced message for the patient, they are sometimes thought to have improved enough to be placed in schools.
  • These methods may risk violating the autonomy, self-expression, consent, and privacy of disabled individuals. 

Facilitated communication evidence is not particularly favorable to the practice. There have been seemingly successful cases like that of Sue Rubin, the focus of the documentary Autism Is a World, who ostensibly learned to communicate thanks to facilitated communication. At the same time, though, facilitators have often been shown to control communication from their patients, whether unconsciously or not. 

Additionally, the scientific community has discredited facilitated communication, and this therapy is not supported by many major health organizations, educational facilities, and autism advocacy groups. For example, the American Association of Intellectual and Developmental Disabilities (AAIDD) doesn’t endorse using facilitated communication therapy. 

Some experts have observed facilitated communication demonstrations and noted that some disabled individuals avoid looking at the keyboard despite ostensibly communicating using it. This exacerbates suspicions that the facilitator communicates instead of the patient. 

There are also many other alternative communication methods for autistic and non-verbal individuals. Facilitated communication should not be confused with these other therapies, though they may include outside support and prompts to help develop communication skills.

Controlled Studies 

Controlled studies may be performed on individuals who use facilitated communication. These studies are conducted by an expert who observes both the patient and the facilitator. During the observation, the expert analyzes what is being written and how much control the patient has when typing compared to the facilitator. Current studies indicate undue influence by the latter in most cases.

Other Considerations 

Autism Is a World should avoid using facilitated communication in their practices. If speech-language professionals ignore the information regarding the harm facilitated communication has on disabled individuals and their families, then they risk liability, especially in cases where a patient or their family is harmed during the use of facilitated communication. 

Additionally, speech-language professionals who choose to use facilitated communication should inform their patients, family members, and guardians about certain evidence-based facts: 

  • Facilitated communication appears to be invalid compared to other forms of communication.
  • Messages created during facilitated communication are often fabricated by the facilitator and provide no genuine insight into the mind of the patient. 
  • The American Speech-Language-Hearing Association doesn’t condone the use of facilitated communication as a therapy. 

Still, despite facilitated communication being shunned by many professional organizations, facilitated communication remains a prevalent fad in some areas. 

Many modify scientific data and evidence to fit what they believe, contributing to the ongoing preservation of facilitated communication. Others make excuses about why facilitated communication therapy doesn’t work for some patients. Additionally, some individuals have invested significant time in researching, studying, and implementing facilitated communication with their patients and refuse to give it up due to the time they have spent. Lastly, herd mentality may affect some individuals who are led to believe facilitated communication works because they are surrounded by others who feel that way.