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

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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.

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Holiday Schedule

It’s the half way mark for school holidays here in Victoria, and it can be a difficult time for kids who rely on the structure and routines of school to understand what is happening in their day.

To help kids understand what’s going to happen each day, you could use a visual schedule. I’ve made some pictures using the Boardmaker software to go with some of the activities we often do with kids during the holidays. Print them out, laminate them and pop some Blu-tak on the back, and stick them up on a wall at home. Then use them to talk with your child about what you’ll be doing during the day. You can also use them at the end of the day to chat about what you did earlier!

Schedule ImagesSchedule

Visual Schedule

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”.

Communicating Without A Shared Language

I’ve recently returned from a trip to Beijing, China and had the unique opportunity to experience communication in the absence of a shared language. Despite the obvious language barrier, I met lots of great people who were keen to chat about my smallest travelling companion (my two year old son). Through the use of pointing, gestures, natural signs and some guesswork, I muddled through with people and was able to interact quite successfully!

Here are some of the things that travelling reinforced for me:

  • Travelling with a toddler is a great conversation starter!
  • You can make an educated guess about the kinds of things people want to know about you when you are visiting another country (e.g. “Where are you from? How long are you visiting?”)
  • Having some visual aids like a map or photos makes communication so much easier. We quickly learnt to favour restaurants with photo-based menus, where we could point out what we wanted to eat and had a reasonable understanding of what we had ordered
  • People seem to really appreciate your effort in attempting to say “please” and “thank you” in another language. My toddler also learnt how to say “Xie xie” for “thank you” and uttering this guaranteed lots of attention!

Session Planning

A lot of work goes into creating a client-focussed session plan at The Communication Toolbox. Session planning typically includes:

  • Consulting with you to ensure that your goals are targeted in sessions
  • Creating resources that assist you to achieve your communication goals
  • Designing activities that create opportunities for you to practise specific communication skills
  • Reviewing the speech pathology literature to ensure that the communication strategies we implement are evidence-based and informed by the latest research