Articles of Interest




Facilitating Communication with Augmentative Communication Devices

Facilitated Communication Training isn’t a device; it is a method to access Augmentative Communication devices. You can use FC with any letter board, icon/picture board, word display, or keyboard, and the device that’s chosen is based on the perceived cognitive and motor abilities of the FC user. Parents and educators make decisions about certain devices based on ease of use, portability, expense, and programming capabilities. Really, the choice of an Augmentative Communicative device is that of the user because the ultimate display of whether the right choice was made is that the person is using it to effectively communicate. It’s not unusual for school professionals to choose a device based on the type of training school personnel on staff already have with a certain devices as well as what the budget will allow to cover the cost. While there is some assessment done relative to what device the professional believes the child can use, oftentimes there is little follow up and training once the family receives the device in the home. I’ve heard many stories about devices sitting on kitchen counters unused for years.

One family we know, Kimbell and her daughter Laura, have tried many devices. The school designated The Vantage as Laura’s Aug Com device when Laura was in 5th grade. The Vantage was programmed with Wordpower and Boardmaker symbols, which are pictorial icons. The problem with pictorial based devices is that others decide what the person can say. The nonspeaking person has to communicate within the programmer’s parameters – not from their own original thought process. Laura wasn’t using it. Four years later, when Laura was in the 9th grade, Kimbell learned that The Vantage could be programmed with a system that is language-based. The program is called Unity and is also known as Minspeak. While it has pictorial icons, it also incorporates the opportunity to type words in combination with the pictures. This feature allows novel and unique expression, and Laura now uses The Vantage with the support of a facilitator who provides her with Facilitated Communication Training. The change in the program as well as FC training has expanded Laura’s use of the device as well as her interest in using it consistently.

School professionals often make the claim that FC is not an evidenced-based intervention, and basically that translates to their believing that facilitators move an FC user’s arm and type words for them. School personnel expect students to use their Aug Com devices independently, without support from anyone. Laura is able to touch some preprogrammed icons on her own, but she needs support to type words from letters. The issue is that using icons is more limiting than words. Her Vantage gives her the power to press icons that correspond to certain phrases like “I want”, and she can choose from a collection of icons that represent nouns. In addition to preprogrammed icons, the Vantage also has a keyboard that can be accessed by on its touch-pad screen. While Laura may be successful at touching icons on her own, if we support Laura to use the keyboard, she would have a broader and more spontaneous means of communicating.

As a person with autism, Laura also has apraxia, and in her case this mostly manifests with her having difficulty initiating movement. That means that Laura will have difficulty using ANY Aug Com device independently until she develops the skill to consciously coordinate her body to consistently touch the letters she wants to touch on a keyboard to spell the words she wants to convey. Laura has shown that she has some pointing skills and that she essentially knows what she wants to point to. Facilitated Communication builds on the FC user’s existing pointing skills with the expectation being that the FC user will type independently over time. The facilitator provides the individual physical support and emotional support to communicate a message. The facilitator also helps the individual monitor his/her behavior in order to focus on the task at hand… all with the intention of supporting the individual to develop greater motor planning skills. The facilitator is does NOT control the message; the facilitator supports the person to learn how to develop more efficient pointing skills so the person can consistently choose their desired target. Ideally, the target will be individual letters on a keyboard so that the person can spell words and therefore, “type to talk”. The short-term goal is to help the person access his/her body to type correctly and consistently so they will have a viable communication system.

Facilitation addresses common problems that individuals with apraxia experience. Apraxia affects how well a person can initiate a muscle to move. One way the facilitator supports this is by helping the person to feel his/her body – particularly his/her arm “in space” so that the person can know from what point the movement needs to begin. Once the person moves the muscle, he/she needs to know how to stop it; and the weight of the facilitator’s touch can help trigger this awareness. We take it for granted that we can integrate more than one movement at a time. A person with apraxia needs help “combing” movements, i.e., managing more than a single movement at a time. The best example of this is that a person with apraxia may have a thought in their mind, but they have difficulty holding a thought they have in their mind at the same point in time they need to move their body to touch the correct letters on a keyboard to spell the word. Facilitators alleviate the stress and hopelessness that the individuals feel because the added support is a welcomed link to the individual to put thoughts into words. The facilitator also supports the person with apraxia to switch movements. The person needs to be able to move from, for example, the letter “a” to the letter “p”. The facilitator helps the person reorient his/herself between each letter so that the person can move from a grounded center point every time he moves toward the keyboard.

The long-term goal is that the person will type independently – without support. The facilitator and the FC user need to keep the long term goal in mind at all times so that the facilitator can continue to fade support as the FC user gains greater motor planning skills. Without giving the person with autism like Laura the support to work through apraxia, the person’s ability to use her Augmentative Communicative device independently will not likely develop. Laura’s mother chose not to use the words “Facilitated Communication training” in Laura’s IEP by instead suggesting that school personnel help Laura with motor planning. In this way, she avoided a discussion of any controversy with the school. The main controversy with FC lies in whether school professionals, school aides, caregivers, and parents can see that a person with autism is fully competent. They need to understand that people with autism and other nonspeaking individuals have thoughts, feelings, and opinions and that they can put them into type-written words. FC users will tell you that they are partners with their facilitators and that they are not being “led” by their facilitators. They have their own voices, and their facilitators helped them escape their prison of silence. I am currently facilitating a nonverbal 20 year male to type his message for me. We began using FC with him in January 2010 believing that he had the ability. Up until that time, he was using his $6.000.00 Augmentative Communication device to primarily ask for food items. He is now beginning to type on an iPad. Last night I asked him to tell me the worse part of having autism. He typed: I hate that I cannot talk. Then I asked him, “What is the one thing you wish you could say if you could talk?” He typed: I would say I love you.

Stephen C. Hartman, LCSW-C
The Whole Self Center
Founder/Director