Autism and Augmented and Alternative Communication | Vol. 4 / No. 18.4

iPad touchscreen keyboard | Photo: David Jackmanson, CC BY 2.0 

Because it’s really hard to tell who’s communicating sometimes.

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This week in the Washington Post, there was an article on the use of an assisted communication technique called the Rapid Prompting Method (or RPM). The idea is that a trained aide helps someone with severe communication difficulties, such as nonverbal autism, to communicate using a keyboard or touchscreen.

I want to be optimistic, but it’s a sticky issue.

RPM is the next generation of assisted techniques following the dumpster fire that was Facilitated Communication, a similar technique in which the aides helped the nonverbal person to type. I put this in italics because I want you to read it again. They held their hands and moved them to where they thought they were trying to go. This is otherwise known as a Ouija board.

Studies time and again showed that it was just the facilitator talking, even if they didn’t realize it. When asked questions the facilitator couldn’t know the answers to, unsurprisingly, neither could the people being asked. People are really good at faking themselves out, and in a very frustrating situation it can give the much-desired illusion of success.

RPM is slightly different, but only slightly. In this case nobody touches the speaker’s hand (that’s important), but in many cases they do hold the keyboard or letter grid (which is problematic). There’s not much in the way of evidence or analysis, either. As the article says,

There is very little research on rapid prompting, in part because [Soma] Mukhopadhyay [the woman credited with the technique] has resisted participating in studies.

I can’t say whether it’s successful or not — all we’ve got are anecdotes. Now let me say that there are definitely people on the autism spectrum for whom communication was made possible through keyboards and other technology, people like Ido Storm for instance. What concerns me is that if there’s any physical intervention, there’s no way of knowing who’s actually speaking. Now I am a little heartened by the end of the article, in which it appears the young man in question is communicating on his own:

He is now able to type without someone holding the keyboard, although the process tires him much more quickly, she said.

On a late November afternoon, Mike sat with the keyboard on the kitchen table in front of him and answered a few questions from a reporter about his Thanksgiving.

“My thanksngi mm. was golden,” he typed. “my cousin Theo” visited and “really had great trimester here,” he wrote, with auto correct filling in the word “trimester.” “HE IS FROM. MINNESOTAN,” he wrote.

In this instance there really does appear to be communication taking place, which (if you’ll allow me to celebrate for a moment) is straight-up awesome. I’m a little concerned by the autocorrect, which probably made “golden” out of an attempt at “good,” and “trimester” out of an attempt at “time” (imagine clumsily striking a QWERTY keyboard, and you get how easy it would be to get “golde” and “trimes” by just hitting adjacent letters), but given the challenges many autistic people face with precise movements, it’s not unlikely. A larger touchscreen would probably help with that. I’m looking at you, Apple.

So, hey. I’d really love for this to reliably work. I really, really would. But that said, that means I’m probably cognitively biased in faovur of positive claims here, so I’m going to have to be really careful. You’ve probably heard the saying “if you’ve met one person with autism, you’ve met one person with autism.” (You might even have heard me say it about myself.) In order for me to get behind RPM, I’m going to need to see some well-designed studies that show it works for more than just one person — and that it’s not open to the problem of interpretation the way facilitated “communication” was.

You can read the full WP article here.

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Richard Ford Burley is a human, writer, and doctoral candidate at Boston College, as well as Deputy Managing Editor at Ledger, the first academic journal devoted to Bitcoin and other cryptocurrencies. In his spare time he writes about science, skepticism, feminism, and futurism here at This Week In Tomorrow.

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