Oral Motor Therapy and Facilitated Communication

…it is far easier to come up with an idea than it is to do the grunt work of scientifically verifying if that idea is a good one.

The stories of both non speech oral motor exercises and facilitated communication are both fascinating, and have sometimes had, at least in the case of facilitated communication, tragic results.  So, then, what are the similarities?  And what can we learn from them?

Facilitated communication (FC) is the technique of using a helper’s hand to guide a severely disabled person’s fingers or hands to type or point at a letter board.  It is a practical requirement that the disabled person must not be able to communicate in any other way.  The facilitator is trained in ways to help hold and support, but theoretically not guide, the patient’s hand to enable communication.  FC was first enthusiastically embraced by many media outlets, and by the general special education community in the 1980’s and 1990’s, before being thoroughly refuted by research, and denounced by every major association that matters,  including the American Psychological Association and the Association for Science in Autism Treatment.  It seemed also that in many cases, these facilitators’ extreme desire to help their students led them to trump up stories of parental sexual abuse – stories that they didn’t seem to realize that they were concocting.  FC seemed to generally fade from the public consciousness, but lately it has been revived.  Unbelievably, Syracuse University helped its reemergence under the re-branding of “supported typing” by promoting its founder, Douglas Biklen to Dean of its School of Education, and by renaming its Facilitated Communication Institute as the School of Communication and Inclusion.  (Maybe these people have been trying to jump on the autism explosion gravy train that earlier FC had just missed?)

Here is a fantastic summary of facilitated communication.  Here is the American Speech-Language Pathology Association’s (ASHA) denunciation of FC.

While oral motor therapy has been less – let’s just say – notorious than FC, it has certainly garnered its fair share of criticism and controversy.

Oral motor therapy has been called different names, one of which is “non-speech oral motor exercise.”  And while this name may not have the best ring it very aptly captures the essence of the controversy of this practice.  Non-speech oral motor exercises are activities, such as blowing, sucking, and chewing, often using objects, such as straws, feathers, plastic and rubber objects, and/or peanut butter, with the intent of increasing strength and coordination of muscles used in speech, such as in the tongue and jaw.  Its use has been very popular despite growing evidence of its ineffectiveness.   A 2008 survey of speech-language pathologists (SLPs) in the U.S. found that 85% of respondents reported using non-speech oral motor exercises.  Although ASHA’s official position is that the evidence doesn’t support, or refute, oral motor therapy (essentially then making it still “experimental”), the evidence has been growing showing that it seems to be a waste of time.  This nice blog post has an interesting analogy by Gregory Lof, who has done a lot of research of oral motor therapy.   The analogy compares oral motor exercises to teaching a basketball player to pretend to hold a ball and then pretend to throw it toward a non-existent hoop with the eventual hope of improving free throwing.  It seems evident that the best way to improve free throw shooting is to use a ball, just as it seems evident that to improve speech is by using speech.

So, what can we learn from the similarities of these two techniques?  These are two cases where emotions and desire have often trumped science, to the continued detriment of the disabled children unable to advocate for themselves.  Ideas for treating communication disorders have and will continue to crop up from the bountiful seeds of human intent to both treat these disorders and give meaning to the lives of their creators and the disabled alike.  That’s fine.  That’s good, in fact.  But it is also a fact that it is far easier to come up with an idea than it is to do the grunt work of scientifically verifying if that idea is a good one.  It is also a fact that it is far easier to take on faith the claims of an idea’s adherents who use dramatic documentaries and tearful YouTube clips as evidence to ignore what might disprove their beloved creations.  The bad news is that it does take work to determine if an idea is good or bad, but as with any bad news/good news scenario, there is good news!  The good news is that we definitely have the capacity to figure out if an approach is good or bad.  Researchers can use good science in the form of the scientific method, double blind tests, replication, and large study sizes.  Consumers of science, which should be all of us, can learn about these things, and demand them while calling out research that doesn’t include them.

Ultimately, these two techniques are well known examples of bias distorting the perception of caregivers’ choices.  There have been an explosion of similar techniques of late, especially those addressing autism, and it behooves all of us to do the grunt work to find out which ones work and which ones don’t.  Something appears to work, and we want it to work so badly that we cling to it, allowing innate human traits of confirmation bias and cherry-picking to cause us to ignore any contrary evidence to our initial conclusion.  It is always good science, and always good practice in general to do that which the evidence best suggests, while remaining open to the possibility that we may just be wrong.