International Journal of Disability, Community & Rehabilitation

Focus on Facilitated Communication: An analysis of international scientific approaches towards a controversial method

Markus Scholz and Jan Markus Stegkemper

Abstract

Facilitated Communication (FC) has ever since been a controversial subject of discussion. But scientific research on the method declined over the years. Nevertheless, recent publication activities are bringing the topic back on the agenda. The goal of the presented study is to identify published studies dealing with FC and to analyze taken research approaches towards the method and their longitudinal development. Therefore, a content analysis of 90 publications was carried out. Results show prevailing but over time varying approaches towards FC. Within dominant strategies (e.g. validation using message passing) certain aspects (e.g. facilitated use of pictorial symbols) are often not examined. Furthermore, we have identified only few studies focusing on prevalence. Based on our outcomes, possible implications for future research are discussed.

A never ending story?

Facilitated Communication (FC), developed by Rosemary Crossley in the late 1970s, has been controversially discussed ever since. Over the years two factions of researchers, professionals and parents were emerging, either they were outright for or against the method. Still the discussion is reignited on a regular basis (ISAAC, 2014), but as Mostert states scientific research on the method declined over the years (2012, p. 20). Nevertheless, recent publication activities are bringing the topic back on the agenda.

FC research a short review

Since the 1990s a lot of studies have been conducted, mostly dealing with the validation of the method. Published reviews show that those studies mostly utilized message-passing as a method to prove whether FC is working or not (see Köhler & Scholz, 2014, p. 133). At the end of the 1990s, the scientific interest seemed to decline (see Mostert, 2010, p. 39) and other approaches to validate FC were used (Bober, 2011, p. 419).

Research Questions

Based on the literature review during a previous study we found that there are very different scientific approaches towards FC and that these seem to vary and change dynamically over time (Köhler & Scholz, 2014, p. 136). These lead us to the following questions:

1. How many studies have been published in the context of FC since 1990?

2. What kinds of methods and approaches are used?

3. How did the application of different approaches develop over time?

4. What kind of symbols are utilized for communication in the studies (written text, pictorial symbols, concrete objects, etc.)?

Data collection

The databases ERIC and FIS Bildung were used to retrieve all publications published between 1990 and 2014. This initial data collection was conducted by our student assistant. Search terms were “Facilitated Communication” and the German equivalent “Gestützte Kommunikation”. We identified 160 articles in ERIC and another 66 articles in FIS Bildung. All bibliographic information including abstracts was gathered and publications using the term “Facilitated Communication” in a different understanding (not meaning the method of Crossley) were excluded.

We then utilized research reviews (Bober, 2010; Biermann, 1999; Green, 1994; Mostert, 2001; 2010; Probst, 2005) to supplement the initial database search , which added another 36 publications.

Afterwards we identified all empirical studies using a two rater validation based on a broad understanding of the term study:

1. Research interest: there is a research question or interest mentioned

2. Sample: an object of investigation is mentioned

3. Method/design: there is a description or documentation of a (methodological) procedure

4. Outcomes/results: some kinds of results or outcomes are mentioned

All publications were successively coded by two raters. Afterwards intercoder agreement was measured in percent (95.2%). To ensure a clear sample, we conducted a discursive clarification of all differently rated segments until we reached full agreement. In the end, 90 publications identified as primary studies were used for our analysis (see references).

Analysis

All studies were categorized in a deductive, concept-driven coding process (Gibbs, 2007, p. 44-45) using MAXQDA. Our previous sorting (Köhler & Scholz, 2014) was utilized as coding schedule. To ensure a clear assignment of codes a corresponding coding manual was written (Bryman, 2012, p. 298-299). Variables in MAXQDA were used to record the year and type of each publication and the location in which a study was conducted. This enabled us to count and visualize different scientific approaches taken towards FC on a timeline and to discuss how these approaches quantitatively varied.

To determine how many studies were conducted we had to distinguish between the publications and the study itself. If there was at least one similar author, we compared the reported samples, to identify multiple publications of the same outcomes. Only the study itself was counted.

We used the same procedure mentioned above, to ensure the reliability of our categorization.

Additional data-driven analysis

In a second step, we jointly revisited all pre-sorted studies in an inductive, more data-driven way (Gibbs, 2007, p. 45) to define sub-categories. The categories and sub-categories were then used to develop a visualization of taken research approaches.

Outcomes

We could identify a total of 90 studies focusing FC (see references). Most were published as journal articles (76.7%), followed by book sections (14.4%), web pages (5.6%) and full books (3.3%). Most studies were conducted in the United States (52.2%) (see table I).

Table 1
Countries of origin of studies (n=90)

Country of Origin	USA	Germany	Australia	Canada	Finland
	47(52.2%)	16(17.8%)	7(7.8%)	6(6.7%)	4(4.4%)
Country of Origin	UK	Italy	Japan	Denmark
	4(4.4%)	4(4.4%)	1(1.1%)	1(1.1%)

The high percentage of German publications can be explained by our sampling procedure. The majority of studies used a quantitative approach (68.9%), 27.8% applied qualitative methods. Combinations of quantitative and qualitative methods were found in 3.3% of the studies. We could identify five main approaches (see figure I).

Figure I. Approaches towards Facilitated Communication (N = 90)

Note. Some studies use more than one approach.

Most studies on the question of validation used message-passing (n = 50), text analyses were conducted in lesser extent (n = 9). The second most common approach focuses on the interactional process between the facilitator and the person who uses FC (n = 21). Studies considering practical use (n = 9) or prevalence (n = 5) were found in lesser extent. A relatively high number of studies were categorized as “other” (n = 19), their contents are taken into account in figure IV.

The application of the different approaches greatly varies over time. Until the year 1999 message-passing-studies were the dominant way of looking at FC (see figure II).

Figure II. Development of the application of different approaches towards Facilitated Communication (N = 90)

Note. Some studies use more than one approach.

Publications utilizing this method rose until the mid-1990s, afterwards they strongly decreased up to the change of the millennium. From 1999 to 2008, studies on FC in general declined. In recent years the scientific interest reemerged. Also more diverse approaches can be seen.

FC is mostly examined as a method based on the usage of written language (n = 83). Pictures, pictorial symbols or concrete objects are often not taken into account (see figure III).

Figure III. Understanding of Facilitated Communication based on the used symbols (N = 90)

Note. Some studies use more than one kind of symbols.

Our data driven approach enabled us to structure the versatile scientific approaches. The studies focus either on (1) one or multiple single settings involving a facilitator and/or a person who uses FC or on (2) one or multiple settings on larger scales (e.g. prevalence) (see figure IV).

Figure IV. Visualization of scientific approaches taken towards Facilitated Communication

The approaches focusing (multiple) single settings, are (1) studies regarding the person who uses FC and his or her social environment (e.g. Lang, 2003; Probst, 2012b). (2) Studies focusing the facilitators (e.g. Bayer, Janz, & Klauß, 2010; Perry, Bryson, & Bebko, 1998; Sipilä & Määttä, 2011). (3) Most approaches raise the question if FC works and take a closer look at the “process” or the “products” of FC processes without a presupposition, e.g. using text analysis. In this regard there are also studies which a priori assume that the method is working and analyze the meaning of statements (e.g. Ashby & Causton-Theoharis, 2012; Biklen, 1997).

Summary and possible implications for future research

Approaches towards FC are methodically diverse although quantitative aspects are dominating. Not surprisingly most studies deal with the validation of the method. The number of message-passing-studies has strongly declined over the years, while especially in recent years a broader variety of methods and questions have been assessed. It seems as if researchers are trying to occupy blank spots in the field. Moreover, most studies understand FC as a method based on written language. Different aspects, like the use of concrete objects, pictures or pictorial symbols are far less considered.

Based on our findings we would like to stress three aspects, which from our point of view are important: First, by strongly focusing on questions of validation and process analyses other things have long been overlooked. It is mandatory to regard that – despite its questionable validity – the method is used in practical situations, presumably all over the world (see Lilienfeld, Marshall, Todd, & Shane, 2014, p.73). Lilienfeld et al. pointed out the danger related to this “science-practice gap” (2014, p. 65). Second, the relevance of written language in FC is not as big as the number of studies solely focusing on this aspect would suggest. Third, the gap spotting strategy and concomitant new approaches are making the field more unclear and perhaps prevent a discussion between different factions. A questionable method which is presumably used in apparent numbers must also be accompanied by questions relevant to the practical field.

References

References marked with an asterisk indicate studies included in the analysis

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Contributors

Markus Scholz
Department of Special Education, Ludwigsburg University of Education

Jan Markus Stegkemper
Department of Special Education, University Koblenz-Landau

Author Note
Markus Scholz, Department of Special Education, Ludwigsburg University of Education; Jan Markus Stegkemper, Department of Special Education, University Koblenz-Landau. Correspondence concerning this article should be addressed to Jan Markus Stegkemper, Institut für Sonderpädagogik, Universität Koblenz-Landau, Xylanderstraße 1, D-76829 Landau, Germany.

Corresponding Author: stegkemper@uni-landau.de