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Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2018 A Single-Subject Evaluation of Facilitated Communication in the Completion of School- Assigned Homework Nancy A. Meissner Antioch University Seattle Follow this and additional works at: https://aura.edu/etds Part of the Developmental Psychology Commons, Early Childhood Education Commons, Educational Psychology Commons, Linguistics Commons, Neurosciences Commons, Quantitative Psychology Commons, and the Special Education and Teaching Commons Recommended Citation Meissner, Nancy A., "A Single-Subject Evaluation of Facilitated Communication in the Completion of School-Assigned Homework" (2018).edu/etds/406 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact dpenrose@antioch.edu, wmcgrath@antioch.

A SINGLE-SUBJECT EVALUATION OF FACILITATED COMMUNICATION IN THE COMPLETION OF SCHOOL-ASSIGNED HOMEWORK A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements for the Degree Doctor of Psychology By Nancy A. Meissner December 2017 A SINGLE-SUBJECT EVALUATION OF FACILITATED COMMUNICATION IN THE COMPLETION OF SCHOOL-ASSIGNED HOMEWORK This dissertation, by Nancy A. Meissner, has been approved by the committee members signed below who recommend that it be accepted by the faculty of Antioch University Seattle in Seattle, WA in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: _________________________ Alejandra Suarez, Ph. Chairperson _________________________ Jane Harmon-Jacobs, Ph.

_________________________ Sara Paul, Ed. ________________ Date ii ©Copyright by Nancy A. Meissner, 2017 All Rights Reserved iii 1 ABSTRACT A SINGLE-SUBJECT EVALUATION OF FACILITATED COMMUNICATION IN THE COMPLETION OF SCHOOL-ASSIGNED HOMEWORK Nancy A. Meissner Antioch University Seattle Seattle, WA Few projects have combined quantitative and qualitative approaches in the analysis of facilitated communication as did this study of a 17-year-old nonverbal autistic male responding to homework questions using facilitated communication.

Findings were consistent with prior studies: Tim was minimally able to produce correct responses independent of facilitator influence under controlled conditions; whereas, at least some typed messages in the spontaneous narratives appear to be his authentic communications independent of facilitator control. An overview of the history of facilitated communication, its related research, and the heated debates around its validity are presented. Disparate findings between controlled and non- controlled circumstances are examined, first within a traditional paradigm, and then within the framework of the past decade’s sensorimotor and neuroimaging research. EEG, fMRI, and DTI neuroimaging studies indicate autism is a disorder of disrupted cerebral neural connectivity - specifically of long-range neural underconnectivity and short-range over- and, to a lesser degree, under-connectivity.

Research linking these findings with the long-discounted sensorimotor behavioral research (and firsthand accounts) indicating aberrant sensory integration and motor planning processes are core features of autism has just begun. 2 A key argument against advocates’ explanations for FC being authentic in some situations but not in others has been with their lack of a substantiating theory. Based on combined evidence from neuroimaging and sensorimotor research, this author theorizes that dyssynchronous activation of brain regions and long-range underconnectivity necessary for higher order integration of sensory input and motor planning, which are exacerbated by increased anxiety and cognitive and emotional demands imposed by controlled designs, explain the disparities between abilities to respond under controlled versus non-controlled conditions. As demonstrated through neuroimaging research, widespread disrupted cerebral neural connectivity appears to be the fundamental neurological mechanism underlying autism with its associated behaviors that have for too-long been socially interpreted and misinterpreted rather than neurologically explained.

This author proposes that as task-based neuroconnectivity research advances, the disruptions in neural connectivity will account for the differing outcomes produced when typing with facilitation under controlled versus non-controlled conditions. This dissertation is available in open access at AURA, http://aura.edu/ and Ohio Link ETD Center, https://etd. Keywords: facilitated communication, autism, supported typing, underconnectivity, sensorimotor integration Dedication It is with deep gratitude that I dedicate this work to Tim, his family, and his aides/facilitators for sharing your lives and experiences, for your perseverance in fighting for the rights of those with disabilities, for your investment of time and energy in seeing this project through to its completion, and for your dedication to contributing to the body of knowledge addressing facilitated communication and the nature of autism. It is also with respect and gratitude that I dedicate this work to all autistics and their families and facilitators who have “spoken out” either verbally or in writing about their internally-lived experiences of autism – on their own behalf as well as on the behalf of all who are and may remain unable or as yet have been unable to communicate their experiences.

Finally, I am grateful to those researchers and clinicians who have listened to and heard those voices, to the firsthand accounts of those who are best qualified to guide science into the most salient and productive avenues toward uncovering the underlying pathogenesis of autism and toward correctly understanding the behaviors that have for too long been misinterpreted and labeled based on etically-constructed and often false assumptions. iv Acknowledgments I want to thank my committee members, family, and friends who encouraged me and believed I could complete this project when I faltered under life’s challenges. It was a difficult, convoluted, and demanding journey that led first through false starts and dead ends, then through frustration and disappointment, and finally through deep mires of information into discovery and understanding. It was a journey that ultimately opened onto a clearing of more comprehensive understandings of autism specifically and scientific methods generally than I had ever imagined.

I especially want to thank Alex, my committee chair, who never failed to support me, but who also challenged me to follow where the leads demanded I go whether or not that was where I had intended or wanted to go; who, while trying her hardest to protect me from my sometimes compulsive pursuit of thoroughness, also taught me the most valuable of research lessons - to stay the course, with dogged discipline no matter how difficult, of pursuing objective scientific inquiry. In the end, this discipline of objectivity taught me to deeply appreciate and embrace two tenets of scientific research – Embrace Paradox: “How wonderful that we have met with a paradox. Now we have some hope of making progress” (Niels Bohr, n.) And examine both the old and the recent with new eyes: “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes” (Marcel Proust, n. v Table of Contents Page Dedication .v List of Tables.

xi List of Figures. xii Chapter I: Introduction .1 More Than a Question of Authorship .2 Firsthand Accounts and Autobiographies .7 Making the Case .14 Chapter II: Literature Review .18 Autism and Intellect .18 Iterations of the Definition of Autism: Has There Been any Substantive Change?. 29 Historical Background of Facilitated Communications .38 The early years. 40 Early empirical test designs.

43 Modifications to empirical test designs. 45 The “resurgence” of facilitated communication. 50 Alternative methods of testing facilitated communication. 59 The Essence of Autism.

66 vi Early brain development .69 The not-so-quiet revolution.71 Neuroimaging brain research. 78 Functional magnetic resonance imaging (fMRI). 80 Diffusion tensor imaging studies. 91 Motor system behavioral research.

102 Sensory systems behavioral research. 110 Multisensory and sensorimotor integration research. 124 Inertia, control, and getting stuck .127 Associative thought patterns .129 Difficulty/inability to stop feeling the change .137 Compensating for an unreliable sense by other senses .138 Other possible sensory and cognitive experiences.139 vii Chapter III: Methods. 145 Sensory integration and perception .149 Developmental history of communication.

151 Facilitators and assistants. 155 Equipment and Materials .155 Preliminary baseline and ceiling ability levels .156 Testing facilitated communication. 157 Chapter IV: Results .161 Preliminary Baseline and Ceiling Levels .162 Qualitative Analysis of Narratives .165 Session 1, pages 2, 3, and top of 4. 166 viii Supplemental Session 2 .170 Facilitator style and influence.

196 Typing from copy. 196 Receptive auditory vocabulary. 197 Quantitative Analysis of Test Results .204 Design elements of controlled testing .210 Qualitative Discussion of Narratives .212 Narrative day 1, Session 1 .210 Facilitator over-control .219 ix Linguistic process analysis .222 The final day, Session 4. 228 Equivocal evidence: Sessions 4, 4, 5, and 5a .233 Qualitative analysis summary .234 Portfolios and anecdotal reports.235 Chapter VI: Conclusions, Weaknesses, Recommendations .241 Journey, Stage One .241 Journey, Stage Two .245 Weaknesses of the Study .254 Appendix A: Word and Photo List .274 Appendix B: Baseline Data: Independent Pointing, Typing, and Receptive Language .276 Appendix C: Daily Protocol Sheets .278 Appendix D: First Responses to Homework Questions: Quantitative Scores .289 Appendix E: Supplemental Communication Sessions: Quantitative Scores .293 Appendix F: Categorization of Typos.296 Appendix G: Permission to Use Copyrighted Figure .301 x List of Tables Page 1.

Possible Internal (self) versus External (other) Orientations of Awareness. Number and Orientation of Errors in Keyboard Key Strikes .175 xi List of Figures Page 1. International 10-20 Electrode Placement System. Left Cerebral Cortex: Broca’s and Wernicke’s Areas.

Medial Surface Right Cerebral Cortex. Right Temporal Lobe Gyri. Cerebral Gyri: Medial Surface. The Limbic System.

Tractographic Reconstruction of Neural Connections via DTI. Diffusion MRI: DTI Color Map. White Matter Fiber Tracts. Diffusion Tensor Tractographies of Neural Tracts.

Superior Longitudinal Fasciculus. Percent Homework Completed .164 xii 1 Chapter I: Introduction Few topics in disabilities studies or special education have incited the firestorm of controversy that swirls around facilitated communication (FC), not just in the professional literature, but also in the media, in educational and therapeutic systems, and within families and homes. In addition, few topics have been cited as often in highlighting the rift between science and practice - the scientist-practitioner gap - as has the continued use of facilitated communication. In her foreword to Lilienfeld, Lynn, and Lohr’s Science and Pseudoscience in Clinical Psychology, Tavris (2003) illustrates the scope of this “gap” as well as the fervor in the divide over the use of facilitated communication in her statement, Today, however, calling it a “gap” is like saying there is an Israeli-Arab “gap” in the Middle East.

It is a war, involving deeply held beliefs, political passions, views of human nature and the nature of knowledge and – as all wars ultimately involve – money, territory, and livelihoods. (xiv) Facilitated communication is a highly controversial form of augmentative and alternative communication (AAC), claimed by many to enable or expand the abilities of individuals with disabilities such as cerebral palsy and severe autism to communicate. Its use is based on the belief that some individuals who are unable to produce speech or use sign language may none- the-less have the mental capacity to communicate given another means to do so. Facilitated communication is a technique through which a facilitator provides emotional and psychological encouragement, varying levels of physical support, and physical resistance to the forward hand movement of the facilitated communication user (henceforth, communicators) to provide motor control.

Physical support may initially involve fully holding the hand or wrist, sometimes with additional isolation of the index finger being necessary to enable the user to select and touch 2 desired selections on a communication board, letter board, or keyboard. For others, touching the communicator’s elbow, shoulder, or back is all that is required, with the common goal being to move toward completely independent typing (Biklen, 1990; Biklen & Schubert, 1991; Crossley, 1992; Szempruch & Jacobson, 1993). More Than a Question of Authorship The most tangible question inherent in the controversy around facilitated communication is that of authorship: Who, in actuality, is doing the communicating – the facilitated communication user - the communicator - enabled by emotional and physical support, or the facilitator acting inadvertently on or through the communicator through some Ouija Board or Clever Hans phenomena?