Thoughts on Facilitated Communication – in Relation to “The Feed” on SBS ” ‘Inappropriate IQ Test’ Results in Thousands Misdiagnosed with Intellectual Disability”


I have just watched the programme that aired last night on “The Feed”: “ ‘Inappropriate IQ Test’ Results in Tens of Thousands Misdiagnosed with Intellectual Disability” and I wanted to share my thoughts.

Firstly, I would like to thank the participants in the program, their families and the people supporting them for sharing their stories.

“The Feed” presented Facilitated Communication (FC) as a communication method that enables people who have complex communication needs to access the education curriculum.

At best, FC locks a person into a communication method that requires another person to physically assist them to communicate and ensures they can never have a private conversation. At worst, FC brings into question the very authorship of the message being communicated.

One of the most problematic findings in FC research is that when the facilitator does not know what the communicator has been asked, the communicator cannot answer correctly.

Access options have changed considerably since FC was devised. Now, people can access communication devices using a switch, head controlled mouse or via eye gaze technology to select items on a screen. Occupational therapists work in this domain to assess, trial and evaluate access options for people who have complex communication needs.

Speech pathologists experienced in AAC (Augmentative and Alternative Communication) identify, evaluate and implement communication options for people who have little or no functional speech. Speech pathologists utilise evidence-based practice when selecting interventions, which means that the strategies they implement have quality evidence to support their use.

Professionals make the best clinical decisions they can with the evidence that is currently available. They consult the research in their field regularly to ensure that their practises are in line with the current data. Importantly, they re-examine their views if and when the research points them in another direction. To consider FC as a viable communication option, we need high level evidence documenting independent and unbiased communication when the communicator has been facilitated to communicate, and high level evidence documenting transitions from the use of FC to independent communication. This data is not yet available.

Currently, we have many different communication options and access methods that can be trialled through a number of assistive technology suppliers around Australia. Victorians with communication difficulties have been able to access the Victorian Aids and Equipment Program, Electronic Communication Devices Scheme to obtain an electronic communication device for many years and we now have the National Disability Insurance Scheme, through which participants can obtain communication devices and mounts to safely attach a device to a wheelchair.

We can certainly do more to improve the educational outcomes for students with complex communication needs. We should increase AAC training for speech pathologists working in schools and provide more OT support. Professionals need to be aware of what communication options are available, how they can be accessed, and what the data tells us about their effectiveness. We also need more education in the community so that families know about potential communication options and where to access services.

At present, FC cannot be considered as a communication option for people who have complex communication needs. We need to focus our intervention on strategies that have been demonstrated in the literature as being effective, and assist the people we support to communicate independently.

As professionals, we need to work towards our own redundancy – so that people with complex communication needs don’t need us to be able to communicate independently.

Agosci 2017 – Part 1

Last week I attended a day of the Agosci 2017 conference and it was superb! I caught up with former clients and workmates, colleagues, and met lots of wonderful people committed to sharing knowledge about Augmentative and Alternative Communication.

Colleen Pearce, Public Advocate, began the day with an interesting presentation about her role in protecting the rights of Victorians who have a disability.

Dr. Cathy Binger’s keynote address made a big impression. We watched a cute YouTube clip of a two year old boy at a supermarket and Dr. Binger categorised his language into four language domains:

  1. Pragmatics (the reasons we communicate e.g. asking questions, commenting, requesting)
  2. Semantics (vocabulary and the types of words we use e.g. nouns, verbs, adjectives)
  3. Syntax (how we put words together in sentences e.g. subject-verb-object statements, questions with inverted auxiliary verb “Can I…?”
  4. Morphology (the little bits of language e.g. plurals, prepositions (“in”, “on”), prefixes, suffixes, contractions)

Dr Binger’s analysis challenged the popular notion that kids’ speech is dominated by requesting and highlighted the need for clinicians to target a wider range of pragmatic functions.

She recommended that we collect information about the child’s understanding of language (receptive language skills) and use language data regarding typically developing kids to offer expressive language options in line with the child’s receptive skill level.

Dr Binger spoke about the pitfalls of aligning with a particular AAC language system or vocabulary option. Instead, we should consider the individual’s needs and how each AAC option could address them. Immediate language requirements were contrasted with a person’s long term language needs and Dr Binger outlined how she uses activity displays in conjunction with the person’s AAC system to address this issue.

Her take home message: “Four domains for today, four domains for tomorrow”.

Supporting People who have Complex Communication Needs: Implementing AAC in Day Services

In An Ideal World

When a person who has complex communication needs (CCN) is learning to use a communication device, the support team should ideally be modelling its use all the time. Initial and follow up training should be provided so that all the key people in the person’s life have the practical skills to set up, use and resolve issues with the communication system. The team should be able to find the words they want to say within the communication software, model them with the person who has CCN and have a plan for adding any messages that are missing from the system.

This is the aim but how do we get there?

How do we make this achievable for busy staff in day services who have numerous responsibilities and limited time?

Although it would be wonderful to jump in and do everything all at once, the reality is that it can take time to amass the knowledge and practical skills to support someone who is not only learning to use a communication system, but might also be learning a new symbol set and access method at the same time.

The acquisition of any new skill can be made easier by breaking it down into more achievable chunks. Supporting the use of AAC is no different.

Obtaining operational knowledge of how to set up a communication system is relatively straightforward. When supporting teams, one of my first tasks is to create a “reader’s digest” version of the manual that includes just the main things– buttons and functions, how to turn it on and off, change the volume etc. Assistive technology suppliers and manufacturers have lots of online resources available and YouTube videos are great too. Facebook is invaluable and there are private groups for professionals, users and families of people using specific communication strategies and technologies where you can share information and learn from one another.

The early stage of implementing the use of a new communication system is about building routines – remembering to take the communication system everywhere, charged and ready for use and learning how to position it safely and optimally so it is always available for the person whenever there is a chance to interact with someone. Establishing these habits leads to the development of operational knowledge as the support teams become more and more familiar with the system.

The next step is to apply the intervention strategy known as aided language stimulation. The communication partner models the use of the communication system with the person who has CCN to teach them what the words and symbols mean, where they are programmed and how they can be used in everyday situations. The communication partner speaks as they access messages in the system, and communicates with the person who has CCN by using their own communication system with them. Modelling requires knowledge of how language in the communication system is organised, so staff need options for obtaining this information.

Communication partners can practise with:

  • Laminated screen shots of frequently used pages from the communication system
  • A light tech version of the person’s communication system
  • Scripts that include step by step instructions for finding the message they want to communicate e.g. I want – Activities – Game
  • A trial version of the communication software if it is available to download

Providing daily aided language stimulation can be one of the most challenging aspects of AAC intervention because it requires everyone to change the way they interact with the person who has CCN. It requires everyone to:

  • Recognise opportunities for communication
  • Find the time to respond to them
  • Model communication options
  • Be patient and provide opportunities for the person with CCN to communicate
  • Model possible communication options if necessary, to demonstrate what the person might want to communicate

It is also a time to manage the team’s expectations. Having access to a communication system is one piece of the puzzle but its presence does not generally lead to spontaneous expressive communication in the absence of aided language stimulation.

We must show the person how to use their communication system by using their system with them.

Interaction Logs

I’ve been trialling the use of “Interaction Logs” in day services recently to make it easier for staff to increase the amount of aided language stimulation they provide for people who have CCN.

The Interaction Log is a data record of interactions that occur in a short period of time between staff and the person they are supporting to learn to communicate.

The team selects a time period e.g. 10:30am-11:00am, or an activity, and then writes down the messages that are communicated with the person learning to use AAC during that time.

Interaction Log

Some obvious considerations:

  • Consent must be provided to collect and analyse information
  • The conversation content should not be sensitive or private in nature
  • Ideally someone other than the communication partner should collect the data as it doesn’t make for a natural conversation if the communication partner is writing everything down!

By focusing on a small segment of the day, for example during a cooking activity, staff can gather valuable information about the number, type and frequency of interactions made between the person learning to use a communication system and their communication partner. They can see at a glance if they are modelling lots of messages or if there is room for improvement. It may also become a valuable record of the person’s journey towards independent communication.

Following the interaction, it is crucial that communication partners reflect upon the success of the communication exchange, to see what went well and to brainstorm ideas to enhance future interactions. After collecting information across a number of times / activities on different days, the team will have a deeper understanding of how the person learning AAC uses their system on a daily basis.

Reflecting on the use of Interaction Logs may be an important catalyst for change if it becomes apparent that the person learning to utilise AAC is not being provided opportunities to access, learn and use their communication system.

It is important for families to know how their relative with CCN is being supported to communicate in environments outside the home. Often families want to know:

  • How much is the device being modelled?
  • Do support staff know how to find the message they want to model?
  • Are a range of people interacting with the person and modelling the communication device or is it the same people each time?
  • Are a range of messages being modelled? Are there lots of questions but not many comments or expressions?
  • Is the communication device available when it is needed? Is it kept near the person? Is it charged up? Is it attached to the mount?
  • Are there issues with using the communication device at certain times?

Gaining a deeper understanding of the communication process and the factors that influence the success of exchanges may assist teams to enhance their support and ultimately, better assist the people they work with to communicate.

Above all, communication is about sharing information with other people, so two of the best things we can do to support people with CCN is to think about common interests that we might be able to chat about, and make some time for communicating.

Acknowledgements & Links to More Information

There are many professionals working in the field of AAC whose work has informed my approach and the information contained in this post.

I would like to acknowledge the work of Gayle Porter, speech pathologist, who developed Pragmatic Organisation Dynamic Display Communication books. I recently attended a PODD Training Workshop and I cannot recommend it highly enough! In addition to providing practical knowledge about using PODD communication books, it also included information about implementing AAC, setting up routines, using aided language stimulation and the importance of modelling a range of pragmatic functions. For more information, please visit:

Jane Farrall is a speech pathologist who writes an excellent blog about topics that relate to literacy, AAC and assistive technology. She also features guest posts and Mary-Louise Bertram’s “Why We Do Aided Language Stimulation – And You Should Too!” is fantastic!

“We Speak PODD” is a personal blog on Facebook written by a family who communicates with their children using PODD books and page sets in AAC devices. The family regularly post videos and share how they model language via PODDs to support their children to communicate.

Kate Ahern’s blog “Teaching Learners with Multiple Special Needs” a great resource. In particular, I love her post “5 reasons to use the high-quality vocabulary already included in your AAC system”.