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In the article, I
argued that although most people think of any “therapy” for children as
beneficial and certainly as safe, there are some treatments still in
use that have the potential for doing harm rather than good. Some of
these treatments have even caused child deaths, though obviously not
all the children undergoing the treatments die or even sustain
injuries. I proposed in the paper that rather than waiting until after
children are hurt, we may be able to identify potentially harmful
treatments for children (PHTCs) by looking at certain characteristics
they share. As a group, PHTCs are implausible—they involve weak logic
and are not in agreement with things that are well-known about child
development. They use methods that resemble abusive actions like
isolating or terrorizing a child. They are also lacking in any
systematic research that supports their effectiveness and safety.
If children (or families)
have already been hurt by a treatment or method, that piece of evidence
should draw our serious attention to the cause of the injury. Researchers
nowadays are told to report adverse events related to the methods they
are investigating, but of course it is much more difficult to study
these relatively rare events than to look at whether a treatment is
effective. Some practitioners will reject reports of harm to treated
children as “anecdotes”, but it has been pointed out that the anecdote
is the first line of defense for maintenance of treatment safety.
Reports of harm are the canaries in the therapeutic coal mine and
deserve attention and analysis.
When I wrote about PHTCs in
that article, I did not even think about including Facilitated
Communication (FC) as an example of a PHTC. I thought FC, a method
claiming to let children who cannot speak or communicate in other ways
with the help of a keyboard and a helper who guides the child to say
what he or she wants, had been rejected years ago! I thought this
because of various canaries in the coalmine in the form of reports that
FC was driven by the helper, and not the child’s intentions, and had
resulted in unfunded accusations of abuse against parents, and
resulting family disasters. But no, not at all, FC is apparently still
around. The following newspaper article describes a conference
advocating FC at the University of Northern Iowa and the distress with
which this has been met by people who understand the FC facts:
Is
FC a PHTC? Certainly, attention has been drawn to the method by reports
of FC-created, unfounded abuse accusations and their adverse effects on
accused parents, with subsequent impacts on the children who are
already severely affected by their disabilities. These reports indicate
that the canaries have stopped singing and we had better see what the
problem is, so let’s look at the other issues involved with PHTC
status.
Is
there evidence from systematic, well-designed, well-implemented
research that facilitators enable communication-disabled children to
make their thoughts and wishes known? No, on the contrary,
when children have seen one thing and their helpers another, the
answers about what they have seen reflect what the adult saw, not what
the child saw. FC keyboarding shows what the adults think, and what
they assume the child thinks—sometimes correctly, no doubt, but always
with a strong chance of being wrong.
Is FC a plausible method? Is it logical and
congruent with what we know of child development? No, it is not. There
is no reason why the introduction of a keyboard would make an adult
especially sensitive to a child’s thoughts. If the adult knew what the
child thinks, he or she could speak for the child, but this does not
happen. The keyboard is simply a distraction from the fact that the
adult is creating the communication, just as a person with a Ouija board
is causing a sequence of letters to be chosen.
Is FC in itself a harmful method, as some child
psychotherapies have directly harmful components? No, it is not in any
serious sense directly harmful for an adult to manipulate a keyboard
together with a child. We might even look for some psychological
benefits of the added contact and interaction. In terms of
communication benefits, however, there may be distinct opportunity costs-- the loss of family time and resources,
as well as the failure to use more effective methods when they exist.
What does the real harm is FC in the hands of some
volunteers or practitioners, who use their position to accuse innocent
parents of abuse and thus create situations in which a parent may not
be allowed near the child (who must be distressed at the disappearance
of a familiar person) and may potentially go to prison if not
exonerated. Even exoneration will not make up for loss of jobs,
friends, even the marriage, as well as disruption of the relationship
with the child. Why are such accusations made? Is it some extreme form
of “rescuing” the child or a way to commit hostile acts against the
parents? This is not clear, but what is evident is that FC, a method
associated with harm, implausible, and rejected on the basis of strong
evidence, is potentially harmful to many if not all children and should
not be taught or practiced anywhere.
When the canaries are quiet, the rest of us had
better speak up.
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