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Some pseudosciences will simply not fade away. They just keep reinventing themselves over and over again. This is partly due to the fact that snake oil peddlers don’t care about science or evidence. But also, knocking down pseudoscience does not usually result in fixing the underlying problem – a lack of sufficient critical thinking skills in the relevant population. So even well-meaning practitioners can repeat the mistakes of the past. That is why advocating for science and critical thinking will always be partly a game of whack-a-mole. Still, we can celebrate the occasional solid whack.

A recent court decision in Pennsylvania is a good victory for science in public school education for children with disabilities, but it also reveals a deep problem of pseudoscience that won’t go away. The decision relates to a technique called Spelling to Communicate, which is essentially a form of facilitated communication (FC).

FC was introduced in the 1980s, and was popular until the early 1990s. The technique is designed to help those with either poor communication or even a complete inability to communicate due to autism or some neurodevelopmental disorder. The basic concept is that such children may have greater intellectual capacity than is reflected in their ability to communicate, which may in turn be limited by purely motor deficits. In order to bypass these motor deficits and access the child’s inner thoughts, facilitators will hold the child’s arm while they point to letters on a letter board. Suddenly children thought to have been severely cognitively limited were writing poetry, and reading and writing at an advanced level.

The extreme implausibility of such results should have prompted immediate skepticism in the speech therapy community, and indeed some were skeptical, but the allure of a transforming method was just too great, and many more therapists embraced the method. FC became popular before critical research was done (always a mistake), and when that research was finally completed it unequivocally showed that the facilitator, not the client, was doing all the communication. Sometimes children were not even looking at the board, as the facilitator rapidly and precisely moved their hand across the letter board or keyboard. Facilitators were largely falling prey to the ideomotor effect, subconscious small movements of their own that were guiding (rather than merely facilitating) the hand movements.

When it became undeniably obvious that FC was nothing but self-deception, it moved rapidly to the fringe. But it never completely went away. It continues to be used by some practitioners, who simply deny the evidence, champion anecdotes, or cherry pick studies that are not designed to determine who is doing the communication.

The lessons from FC are clear, and should stand as a cautionary tale for every practitioner.

  • First, do not accept and widely use a technique that has not yet been validated by adequate research. The research should come first. Until then, new techniques should be treated as experimental.
  • When something seems too good to be true, be especially skeptical. It is the duty of every professional to do due diligence, and make sure they are not harming their clients. So don’t get caught up in a “miracle” treatment or intervention – be skeptical.
  • The research that matters most are studies designed to rigorously answer the question – is the phenomenon real? This kind of research requires proper blinding. In the case of FC (like many deceptive pseudosciences) the alleged effect vanished under proper blinding.
  • Listen to the research. Do not make excuses for negative results, or simply ignore it in favor of lesser research that is not capable of disproving your preferred method.
  • Do not underestimate the potential for self-deception.

Many people simply did not learn these lessons. They continue to champion FC. Also, as time goes by new generations of practitioners come up who may not have learned the history of FC, and so repeat the mistakes of the past. For example, in 2010 a prominent neurologist and coma researcher fell for a clear case of FC. They were simply not aware of the history and were fooled. To their credit, they eventually performed the kind of blinded test they should have done at first, and exposed the FC as invalid. Look at the video here. It is a dramatic example of how impossible it would be to actually communicate using this method. The facilitator is moving the clients hand over the letter board at an impossible speed.

Another way in which such pseudosciences survive is to simply rebrand themselves. In the case of FC we now have virtually identical methods, known as Rapid Prompting Method (RPM) and Spelling to Communicate. These methods also use a facilitator to help a client point to letters on a board. With the Spelling to Communicate method, the facilitator holds the board, rather than the clients hand, but this still allows for the ideomotor effect. Why not have a stationary board?

The facilitators often have to direct clients, ignore incoherent spelling, and “reset” them if they are not giving a meaningful response. Videos remind me of the Clever Hans effect – clients pointing at seemingly random letters until they hit the “correct” letter, which is then counted. Now of course clients exist on a spectrum, and some do have the cognitive ability to communicate but may be non-verbal or have impaired communication. So it is possible to cherry pick examples of clients who can actually communicate with a letter board, as if that validates the process itself. Such cases are not representative, and do not validate the specific techniques used, or justify the lack of proper controls.

The American Speech-Language-Hearing Association (ASHA) has reviewed the evidence for RPM and Spelling to Communicate and warned against their use. They conclude there is no evidence that the clients are actually doing the communication. They write:

According to Davis-McFarland, such positions have been and continue to be marked by deep concern about a range of potential serious harm that includes “reduced access to effective and appropriate treatment, denial of the human right to effective communication, and victimization of individuals with disabilities and their families with false hope and wasteful use of personal and professional resources.”

So officially such techniques are not evidence-based or professionally sanctioned. That does not stop private companies from using their own brand of FC in order to prey (whatever their intentions) on desperate parents. Often school systems become involved, because parents might demand that the school system uses and pays for these methods. This is where the recent courtroom victory comes in. A recent Pennsylvania court decision (ODR File Number: 21855 / 18 – 18AS, link not yet available) denied parents compensation for their private use of a company providing Spelling to Communicate.

The ruling hit many important themes. It concluded that the technique is not recommended by the ASHA because it is not scientifically valid. But further, it reaffirmed that parents cannot demand of a school system that a specific method is used. This is important because otherwise pseudoscience could be foisted onto public institutions at public expense.

This principle has broad implications. It is increasingly a problem that insurance companies are forced by legislatures to cover pseudoscientific treatments, for example. Rather proper experts should dictate the standard of care based on the best current scientific evidence available.

But also this small case reflects another reality – there is constant pressure from countless pseudosciences to infiltrate academic, scientific, professional, and public institutions. Guarding against such harmful and wasteful intrusions requires constant vigilance on the part of experts and professionals. But this, in turn, requires that professionals are properly educated about the history of specific pseudoscience, and the methods necessary to ward against them. No physician, or therapist, or speech pathologist, or similar professional should be able to get through their training without learning about basic scientific methodology, critical thinking, the pitfalls of self-deception, and the methods used by charlatans and snake-oil peddlers.

Otherwise we’ll be playing a losing game of whack-a-mole.

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Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.