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A SINGLE-SUBJECT EVALUATION of FACILITATED COMMUNICATION in the COMPLETION of SCHOOL-ASSIGNED HOMEWORK a Dissertation Presente 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.D. Chairperson _________________________ Jane Harmon-Jacobs, Ph.D. _________________________ Sara Paul, Ed.D. ________________ 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.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/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.d.) 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.d.). v Table of Contents Page Dedication ...................................................................................................................................... iv Acknowledgments ...........................................................................................................................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 .......................................................................................................38 Controversy erupting ............................................................................................ 40 Early empirical test designs .................................................................................. 43 Modifications to empirical test designs ................................................................ 45 The “resurgence” of facilitated communication .................................................. 50 Alternative methods of testing facilitated communication ................................... 57 Linguistic ................................................................................................. 57 Eye tracking ...............................................................................................59 High Stakes ....................................................................................................................... 59 The Essence of Autism. .................................................................................................... 66 vi Early brain development ........................................................................................69 The not-so-quiet revolution....................................................................................71 Neuroimaging brain
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