Date: June 3, 2025

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Preamble: Speech and Language Therapy Singapore (SALTS) is dedicated to promoting the highest standards of professional practice in communication and swallowing. Our commitment is to advocate for and provide evidence-based and effective interventions that support the communication rights and needs of all individuals. This position statement addresses the practice of Facilitated Communication (FC) and its variants, aligning with international best practices and the ethical responsibilities of our profession. While the use of FC is not widespread, there have been isolated reports of its application in educational and therapeutic settings. SALTS is committed to supporting local Speech Therapists (STs) and families in receiving evidence-based approaches. Our stance aligns with the ones taken by leading global organisations such as the American Speech-Language-Hearing Association (ASHA) (refer to https://apps.asha.org/EvidenceMaps/Articles/ArticleSummary/fe1f86c6-a066-4039-83a8-f4bf54380105) and the International Society for Augmentative and Alternative Communication (ISAAC) (refer to https://isaac-online.org/wp-content/uploads/CAAC-Position-Statement-on-Expressive-Methods-of-Communication-PWUAAC.pdf). Our goal is to ensure that all individuals have access to interventions that are effective and culturally appropriate. 

 

Position Statement: SALTS unequivocally opposes the use of Facilitated Communication (FC) and all its variants as a legitimate or evidence-based intervention for individuals with communication difficulties, including but not limited to autism spectrum disorder, intellectual disability, and other complex communication needs. This position is based on a comprehensive review of scientific literature, ethical considerations and the consensus of leading professional organisations including ASHA and ISAAC.

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Definition of Facilitated Communication and its Variants: Facilitated Communication (also known as Supported Typing, Spelling 2 Communicate, Hand-over-Hand Communication, or Rapid Prompting Method where physical support is provided) is a technique in which a facilitator provides pervasive physical, emotional, or verbal support to an individual who is purportedly communicating by typing on a keyboard, pointing to letters/pictures, or writing. The facilitator typically holds or touches the individual's hand, arm, or shoulder, or provides other forms of physical or gestural prompts.

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Rationale for Opposition:

1. Lack of Scientific Validity and Evidence: Decades of rigorous, controlled scientific research have consistently failed to demonstrate that the messages produced through FC originate from the individual with communication difficulties. Instead, studies have repeatedly shown that the messages are controlled or influenced by the facilitator (Hemsley et al., 2018; Schlosser et al., 2014). There is no current evidence to support the claim that FC unlocks hidden communication abilities or that it results in independent communication by the individual.

2. Profound Ethical Concerns and Potential for Harm:

   • Misattribution of Authorship: When messages are knowingly or unknowingly influenced by the facilitator, the communication is not driven by the individual with communication difficulties. This can lead to serious consequences, including false accusations, misrepresentation of an individual's thoughts, desires, and abilities, and misguided life decisions based on non-authentic communication. Both ASHA and ISAAC have highlighted this critical issue, emphasising that true communication must originate from the individual.

   • Violation of Autonomy and Self-Determination: The practice undermines the autonomy and self-determination of individuals by potentially imposing the facilitator's thoughts or interpretations as the individual's own. This directly conflicts with the fundamental right to independent and autonomous communication.

   • Delayed Access to Effective Interventions: Reliance on FC can divert individuals and their families from pursuing and implementing evidence-based interventions that foster genuine and autonomous communication skills.

   • Erosion of Trust: The use of unvalidated methods can erode public trust in speech and language therapy as a profession committed to scientific rigour and ethical practice.

3. Inconsistency with Evidence-Based Practice: As a profession, speech and language therapy is founded on the principles of evidence-based practice (EBP) which requires the integration of clinical expertise, client values and the best available external scientific evidence. FC does not meet the criteria for an evidence-based practice and thus should not be endorsed or utilised by SALTS members.

 

Recommendations:

SALTS urges all speech and language therapists in Singapore to:

1. Refrain from Using FC: Do not employ Facilitated Communication or any of its variants in clinical practice, research, or training.

2. Educate and Inform: Educate individuals, families, caregivers, educators, and other professionals about the lack of scientific validity and the potential harms associated with FC, referencing the findings of professional bodies like ASHA and ISAAC.

3. Promote Evidence-Based Alternatives: Advocate for and implement communication interventions that are supported by robust scientific evidence and promote independent communication. These may include, but are not limited to, Augmentative and Alternative Communication (AAC) systems (e.g., picture exchange communication systems, speech-generating devices, sign language), social communication interventions, and other person-centred approaches that genuinely support independent communication and respect the individual's autonomy.

4. Adhere to Ethical Guidelines: Uphold the highest ethical standards of the profession and ensure that all interventions are client-centred, respectful of individual autonomy and grounded in scientific evidence.

 

Conclusion: SALTS remains steadfast in its commitment to promoting effective and ethical communication practices. We believe that all individuals deserve access to communication methods that are scientifically validated, respectful of their autonomy and reflective of their own voices. By taking a firm stance against Facilitated Communication and its variants, SALTS reaffirms its dedication to protecting the rights and well-being of individuals with communication difficulties and upholding the integrity of the speech and language therapy profession in Singapore.

 

References: 

Hemsley, B., Bryant, L., Schlosser, R. W., Shane, H. C., Lang, R., Paul, D., … Ireland, M. (2018). Systematic review of facilitated communication 2014–2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism & Developmental Language Impairments, 3, 1–8. https://doi.org/10.1177/2396941518821570 https://journals.sagepub.com/doi/pdf/10.1177/2396941518821570    

 

Schlosser, R. W., Balandin, S., Hemsley, B., Iacono, T., Probst, P., & Von Tetzchner, S. (2014). Facilitated communication and authorship: A systematic review. AAC: Augmentative and Alternative Communication, 30(4), 359–368. https://doi.org/10.3109/07434618.2014.971490 https://www.tandfonline.com/doi/full/10.3109/07434618.2014.971490