Facilitated Communication (FC) was first used with people with Cerebral Palsy as a communication system for people who could not use their bodies to easily connect to intelligible verbal speech or could not control their bodies enough to easily point to a letter board without assistance.

Facilitated Communication involves, pointing to words, pictures or letters to communicate choices or express oneself. Often word grids or letter boards are used but some people use electronic hand held voice communicators which electronically speak what the person has typed- giving the person an external 'electronic voice' where they cannot use their own.

Facilitated Communication involves hand over hand assistance with pointing or typing and this is where it became very controversial when used with people with autism, who unlike people with Cerebral Palsy, were seen as unable to even conceive of what they wanted to say. The FC communications of people with autism were criticized as 'hoaxes' being controlled by the facilitator who had control of the hand or pointer finger. This was especially so in people whose severe exposure anxiety caused such constant involuntary aversion, diversion or retaliation behaviors or communications, that their exposure anxiety made them appear too 'retarded' or too 'disturbed' to be capable of communicating the rational thought which then came through in FC communications.

Critics, not understanding the mechanics of Exposure Anxiety, as people often only able to free up communication when they can do it 'as someone else', 'for someone else' or only when 'with someone else', put these people under scrutinized test conditions. These were generally the kind of directly confrontational social conditions which would automatically ignite instantly sense of exposure, by forcing the person's awareness this was THEM having to prove they were communicating BY THEMSELVES, AS THEMSELVES, FOR THEIR OWN BENEFIT. Of course, these conditions, ignorant of the mechanics of exposure anxiety, caused almost all to then involuntarily avoid, divert from or retaliate against their own 'watched' communications. This combined with their use of peripheral vision rather than directed looking at their letterboard communication was taken by non-autistic professionals as 'proof' the non-scrutinized communications could never have been their own- a self-fulfilling prophecy and one which left many with then no method of indirectly-confrontational communication.

In the absence then of no form of communication which they could attribute to outside of them rather than feeling it intensely as 'self', these people went back into either silence, communicating through their 'disturbed' behavior or communicating indirectly through song, adverts, etc. All of these means of indirectly confrontational communication, of course, are generally far harder to make sense of than their pointed or typed communication.

Some persisted in spite of apparent failure, extending the number of people they allowed to facilitate their communication, even speaking it as they typed it. Some have been able to progressively combat their exposure anxiety to eventually handle the facilitator gradually fading out the degree of support. From hand over hand to guiding the hand gently, to holding the arm, not the hand or finger, to simply supporting the arm, to simply touching the arm, some people have been able over years to eventually allow people to witness their, now independent, typing. Some have progressed to needing only the simple touching of the shoulder and eventually, just standing by, with the occasional touch on the shoulder to allow the person with exposure anxiety to reassuringly convince themselves this was not truly just them communicating but that they were controlled from outside. This would allow such people to attribute the responsibility for expression to the other person's influence, freeing them from the rock solid grip of exposure anxiety. In fact ironically, it is the very emotional self-tricking of it not being one's own responsibility that made FC such a potential avenue for people with severe EA. Their very strategy for freeing up expression, in the hands of critics was to cause them to be robbed of this media of communication leaving them with a voice and body which was governed by their exposure anxiety and impractical for functional communication in the non-autistic world.

My suggestion regarding FC is that it should be used keeping the rules of Exposure Anxiety in mind. The facilitator should do it, not as though it is for the benefit of the person with autism, but as though they are using the person's finger to type what they expect to hear. As the facilitator then begins to hold back or slow down at the last moment they may begin to feel the person with autism 'prompt' the movement slightly. The facilitator should then 'comply' without drawing attention to this being the person with autism's own communication (to do so would be to kill the potential of the technique or dialogue with most people with severe exposure anxiety). The facilitator should use FC in small doses, as though for their own benefit, leave out praise, address the issues communicated NOT the person communicating (do not push a sense of ownership onto the person with exposure anxiety or they'll disown the activity). The facilitator should always leave the activity with the person still wanting more. This is the only way to build want and have the person not reject the technique and actually seek longer involvement each time. The facilitator needs to be warm, committed yet nonchalant (playing a little hard to get, aloof) in their attitude, keeping their excitement at any communication to themselves as though it is for their own benefit, not putting that excitement on the person with Exposure Anxiety. Be pleased not with the person with Exposure Anxiety but with the communication as an object. If necessary, refer to the person with EA in the third person if this helps them distance themselves enough to free up expression. Some facilitators find it most helpful to pull back the persons hand from the board, triggering retaliation against them and towards communication.

A good facilitator sees themselves as a role rather than a person. They are a tool via which a person can attribute their communication outside of themselves in order to communicate outside of the controlling and sabotaging reactions caused by exposure anxiety.

In starting, multiple choice often works better than open discussion as it can be attributed to the question having already answered itself rather than the person answering an open ended question. Similarly, giving a wrong response will often trigger a correction. Remember, don't make a show of things. Although people with EA may initiate attention when THEY are in control of it, people with EA will often self sabotage just to get your attention/praise off them when you try to initiate it.

If we think of Exposure Anxiety as a kind of emotional equivalent to Cerebral Palsy in its effect on speech and the use of pointing, even looking, we begin to get an idea of why FC may just be worth trying with some people.

There are a number of parents and professionals who use this technique. Some functionally 'non-verbal' teenagers and adults (who mostly appeared to have never shown they could read or write) have managed to go to higher education, using a voice communicator after progressing well with FC. In spite of this, they remain often visibly 'autistic', although the technique can give some people control, choice and independence in their lives. Some now type independently and speak what they type as they type it.

You can see examples of grids to help with Facilitated Communication by clicking on this link.