ASHA Discourages Use of Facilitated Communication, Rapid Prompting Method

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People With Communication Disabilities Have a Right to Services That Are Effective, Lead to Independent Communication, and Are Not Harmful, ASHA Says

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Underscoring the importance of scientifically defensible communication interventions and citing shared concern about harm that could stem from baseless practices, the Board of Directors of the American Speech-Language-Hearing Association (ASHA) has unanimously approved position statements that discourage the use of Facilitated Communication (FC), the Rapid Prompting Method (RPM), and similar practices such as Spelling to Communicate—techniques where “facilitators” ostensibly elicit communication from individuals with disabilities.

These position statements strongly encourage the use of effective augmentative and alternative communication (AAC) systems. The statements do not apply to independent typing.

Overall, ASHA’s new position statements are the result of a year-long process that featured an open peer review. Ultimately, ASHA received 1,100 comments about the positions that ASHA has taken with respect to FC and RPM when they were proposed. Comments were submitted by speech-language pathologists, audiologists, teachers, other professionals, individuals who use FC and RPM and their families, and advocacy groups. Overwhelmingly, ASHA members expressed support for the positions as proposed.

“ASHA’s new position statements on FC and RPM are rooted in abiding respect for individuals with disabilities and the belief they have a right to services that are effective, do not cause harm, and foster independent communication,” said ASHA President Elise Davis-McFarland, PhD, CCC-SLP.

ASHA rarely takes stands about particular intervention techniques. However, when the evidence against an approach is undeniable, ASHA must caution its members and protect the right of individuals with disabilities to an independent means of communication.

ASHA first cautioned against the use of FC in 1995. Since then, multiple systematic reviews—the highest level of scientific evidence—have continued to show that the “facilitator” is doing the communicating. Based on the preponderance of replicable, objective studies over 3 decades, members have urged ASHA to adopt a stronger position against the invalid and ineffective technique. ASHA’s new statement warns that FC should not be used.

RPM has been in use for at least 17 years and bears considerable similarity to FC. ASHA’s position statement says that RPM is not recommended because of prompt dependency and lack of scientific validity.

As many as 19 other leading professional organizations have long cautioned against or prohibited the use of FC. And at least three other speech-language pathology organizations in Australia, Canada, and Ireland have also taken stands against the use of RPM.

According to Davis-McFarland, such positions have been and continue to be marked by deep concern about a range of potential serious harm that includes “reduced access to effective and appropriate treatment, denial of the human right to effective communication, and victimization of individuals with disabilities and their families with false hope and wasteful use of personal and professional resources.”

She added, “The approval of the position statements demonstrates that, as a professional and scientific organization, ASHA is committed to upholding the use of and reliance on high-quality research when developing practice policy and standards for its members. As in all practice areas, ASHA will continue to monitor the literature on FC and RPM.”

About the American Speech-Language-Hearing Association (ASHA)
ASHA is the national professional, scientific, and credentialing association for 198,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Audiologists specialize in preventing and assessing hearing and balance disorders as well as providing audiologic treatment, including hearing aids. Speech-language pathologists identify, assess, and treat speech and language problems, including swallowing disorders.


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Francine Pierson
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