Executive Brief: Spelling is a valid way to communicate.
“Spelling to Communicate” (S2C) is a nascent therapy that is suffering in its association with facilitated communication (FC), which we discuss elsewhere as a type of hydra oil.
S2C could escape those bonds if it divested itself of its FC hallmarks; however, it has yet to do so.
We map the route that S2C could follow to become an evidence-based therapy, albeit perhaps by another name.
Details…
We cast no doubt whatsoever on the emergent glory of anyone’s Self. We presume potential.
We are not here to destroy Spelling to Communicate (S2C), far from it; in fact, we are trying to differentiate as much baby as we can from out of the rather murky bathwater (that has already dunked a spluttering herd of filthy tyke-sibs); in that sense, this work is neither a wholesale condemnation nor a universal blessing.
No matter how you feel about S2C right now, how would you feel if it were made better? Wouldn’t that be a good thing? Every genuine therapy should welcome thorough review by qualified evaluators, whose aim is to coalesce any apparent benefits while removing any evident harm.
So let’s do it. (And peace be upon you.)
Let’s actively, unequivocally distinguish S2C from facilitated communication (FC); after all, when it comes to evaluator qualifications, ours are substantial. We’re no joke. We really know what we’re talking about here. (Really really.)
Having thus staved off summary dismissal in this fraught context (one hopes), let’s begin…
If S2C were redesigned to prioritize the end goal of autonomy, including the entire removal of the facilitator’s influence, then it would stand a much greater chance of being sufficiently distinguished from FC.
This should not be controversial among practitioners of S2C, as they claim that they do not use facilitators.
S2C demonstrably does use them, but that’s fine.
Strange as it might seem, that in itself is not a concern.
The main issue is that unlike other therapies that address motor planning, S2C leaves facilitation residue in place indefinitely; and ultimately, that design decision does not prioritize a generalization to autonomy. That problem needs fixing because disregard for that residue favors the needs of the communication partners over those of the communicator, which is a hallmark of FC.
So if S2C really does not want to be a type of FC, then they will fix that.
Some people will contend that there is no such residue. They might simply be unaware of it; nonetheless, there are straightforward ways in which we can demonstrate that it remains, which tends to be detailed below.
Given the S2C grounding in spelling, it should be redesigned to rely on curricular programs designed by trained spelling teachers, otherwise this is actually Keyboarding for Communication (where a letter board is functionally a minimalist keyboard). Allow the client to develop their spelling through existing, effective, evidence-based, natural phases that are client dependent, not facilitator dependent.
Spelling is absolutely a valid way in which to communicate, as is the use of such tools as keyboards and letter boards for sequenced spelling expression. There is a good deal of existing research that analyzes the various paths that people take as their spelling develops. In a therapy like this that relies not just on spelling, but on learning to spell, it is crucial to take that information into account.
Happily, there is an essay in Residual Trace entitled “School-Age Spectral Spelling Development” that synthesizes that research. We encourage you to read it. We are tickled pink (or thereabouts) to have finally found a good use for that work.
We note (without rancor) that S2C currently expresses no apparent concern over the lack of spelling pedagogy in their program. (Please note that answering reading comprehension questions is not how you teach spelling.) Clients are currently only able to access and learn what their facilitator knows how to spell; furthermore, clients adopt the spelling mistakes that are found in their facilitator’s patterns.
S2C expresses strong support for getting their clients to the point where they can answer open-ended questions, which is good; however, clients are not able to give truly open-ended answers if they have not been taught how to access the spelling of whatever they might want to express. That is one part of the facilitator residue. Sure, you can say that the client only ever wants to talk about those things that use the specific words that they have been taught, but how can you possibly know that unless they tell you? Do not favor the needs of the facilitator in this fashion (or any other, for that matter), as that is also residue.
One response argues that S2C does not teach actual spelling precisely because the clients are not able to activate motor plans in that way, which is surprising because that attitude does not presume potential, where the presumption of potential is supposed to be promoted by S2C.
Beyond this answering of open-ended questions, the lack of spelling instruction limits the client’s ability to engage in spontaneous, truly autonomous expression. They need opportunities to do more than answer questions, and to do so when they feel like it, not just when prompted. This dependence (along with the board needing to be held) is part of what FC calls “borrowed activation,” which again makes it difficult to identify S2C as different from FC.
On top of everything else, S2C needs to address the observed phenomenon where a client immediately adopts the spelling patterns of any previously unfamiliar facilitator. If there is a legitimate explanation for this sort of event other than facilitator dependence, then S2C needs to figure it out before they can validly claim that no facilitator is used.
Put the board down and move out of the client’s field of vision.
S2C needs to get to both of those places.
Without a research base to which we might refer, there is no way for us to say with sufficient confidence what physiological mechanism, exactly, S2C is supposed to be relying on. Yes, speculations and explanations abound, and they all seem to suggest that the client is bypassing the planning part of the system and loading it up with a set of motor plans that have already been planned, which will be refined and entrenched over time.
Specifically, the client is exposed to one form (such as hearing the spoken sound of the letter ‘a’) that is associated with a meaning (the concept of ‘a’), and in that context they learn to express a different form (namely their movement to select the target letter ‘a’). They are supposed to execute their current plan for that expression, one that starts out being executed poorly (we can only observe the execution, not the plan, so it might have been planned well), during which they are trained to refine that execution until it is deemed to be accurate and reliable. That training involves the facilitator moving the target around and providing verbal prompts to help the client get a hit.
And then they do this until they can reliably execute 26 or more variations on the theme. And then of course sequences of letters that form words and sentences are treated as more complex plans. It is difficult to figure out what the S2C stance is on the cognitive organization of these more sophisticated units. One hopes that it is not the whole gestalt thing.
Note that there are also variations in which clients do not appear to have difficulty in accurately touching whatever they chose with precision, and S2C really is focused on such higher-order sequences as words and sentences.
How does this compare to other motor planning therapies?
There are various ways in which someone might not be able to exercise volitional control over their motions. Plenty of solid research exists to demonstrate that some such people benefit from ‘motor planning’ types of therapy, like these:
This table is only broadly illustrative, ignoring overlaps between adjacent domains. The point is that therapy for motor planning has value. That claim in itself is not disputed.
Neither is the use of therapist-specified targets in the early stages of therapy, such as demonstrating how to make specific sounds, how to hold a pencil and shape certain letters, or where to place one’s feet. The therapist establishes targets so that they can render professional judgments about the client’s accuracy and precision, and adjust therapy accordingly.
When a therapist models speech sounds, the client’s mirror neuron system helps them to figure out how to change their articulators to more closely match what the therapist is doing (if their mirror neuron system is intact, and their physiology is similar to that of the therapist). In S2C, the facilitator is not modeling the motion that the client should match, but rather they are moving the target and guiding the client with spoken prompts.
Now here’s an important part…
Over time, as their skills develop in matching the therapist’s targets, the client can increasingly generalize the application of those skills their own selection of targets. Access to that autonomy is the moral imperative that drives the design of every valid approach to AAC. Every effort is made, explicitly and intently, to remove the influence of any partner on the meaning of the client’s intended message. If S2C really wants to be a valid form of AAC, then it must meet this standard.
So you can understand why S2C has such a big PR problem here, given the displayed influence of the facilitator during the training, and insufficiently persuasive demonstrations of the removal of facilitator residue. In this very work, we are considering what might be done about that.
So let’s talk more about that influence, and its risk of harm.
S2C specifies a facilitator holding the edge of a letter board while remaining in the client’s field of vision, where the client then points to letters on that board to spell out sequences of words. In the initial stages, the facilitator moves the board (and sometimes the client’s arm), sometimes with verbal prompts, to help train the motor patterns.
As stated earlier, shared target knowledge is necessary during certain steps of motor planning therapy. The facilitator knows which board to present in those cases where the alphabet has been distributed across multiple sub-boards. As a training stage, this would not be a problem, if prioritizing eventual access to autonomy were worked into the design at every stage.
But it is not.
Always look ahead to a time when the student will move along to a system where no one is holding the board. Too many demonstrations of the method make it plain that the facilitator is still moving the board enough to influence which letters the client is selecting. Some of this is due to the fact that the facilitator has spent so long moving the board that their own motor relationship is an entrenched reflex, and they might not even notice what they’re doing. The facilitator is also giving the client feedback with their facial expression, posture, and residual verbal prompts, and I quote, “getitgetitgetit.” S2C needs to getit all out of there. No microcueing. True independence.
S2C also needs to address those cases where a client is reported to create very long sentences when someone is holding the board in front of them, making little noises, and so on, but then they are not able to select letters when they are presented on a touchscreen in front of them.
No, those form factors are not identical. Yes, that might make a difference. There might be effects of OCD and anxiety in regard to the changes. The touchscreen might be sensorily irritating. All of those things and more might well be true.
But none of them are reasons to leave a student dependent upon a facilitator.
Encourage the client to discuss topics that are so unfamiliar to the facilitator that they become a genuine partner.
The facilitator also knows the target in a stage that relies on the client producing answers to such closed questions as those used to measure reading comprehension. In this phase, correct answers are often wholly attributed to the client relying solely on their own knowledge even when facilitator prompting is still readily evident. Inaccurate answers are often attributed to deliberate ‘teasing’ or ‘joking’. This sort of pattern is not uncommon in AAC, where partners really want the client’s answers to signify intentionality. There are practices to help distinguish between the two. S2C should use them.
What you want to establish is a privacy of meaning that wholly distinguishes between the client and the partner. Except for the possible case of telepathy (on which we take no stance in this essay), communication partners do not actually share the embodied part of their minds (although their extended cognition might overlap).
A good test is one where the topic is proven to be entirely unfamiliar to the facilitator, or better yet, one about which they have been deliberately misinformed. If the student still produces a correct answer, despite the facilitator either being ignorant or thinking that the client’s expression would represent a mistake, then that tends to support the assertion of agency on the client’s part.
As things stand, however. there are cases where the S2C client spells out what only the facilitator thinks is the right answer.
We are not saying that this is due to deliberate intent on the part of the facilitator. We are saying that without regard to intent, this facilitator influence does not promote the client’s access to autonomous expression.
Support for S2C often comes in the form of the claim that the student is providing their own answers to open-ended questions, which would be a wonderful step on the road to independence and autonomy. The assumption is that the answer must therefore be unknown to the facilitator. But this is a false premise, and was one of the distinct ways in which FC was roundly debunked. The client was only giving the answers that the facilitator expected. S2C needs to foster privacy of meaning if it wants to escape the shadow of FC.
Keep in mind that facilitators are sometimes said to be unaware of their influence. As alluded to earlier, the effect is worse when the facilitator has entrenched their own motor (and other) patterns because they have acted for so long as the trainer.
Regardless of intent, this consequence still robs the client of their autonomy.
If S2C were to address the these contentions, then it would be in a position to establish an evidence base.
And wouldn’t that be cool? It would be one less thing for people to fight about.
And if that evidence base were able to be established, then a very important improvement would ensue, namely…
Stop presenting the fanciful S2C rationalizations that contradict firmly established science. They do not explain what is going on in S2C. Pseudoscience is a hallmark of quackery, and its use aligns S2C with FC. Instead, research the real explanations.
When that truth is available for you to tell, stop insisting that a client’s speech must be ignored during S2C training sessions. The fictional rationale for this abuse is that the motor planning system would be overwhelmed by trying to do two things at once, so the facilitator can only allow motor planning for pointing at the board. This story might sound like common sense to some people, but it is wrong. It disregards what the client’s neurological system is actually, factually doing, even if their motor planning is compromised.
Vosseller is adamant about this rule. So you can either stand by this person who adapted the technique from Rapid Prompting Method, or you can modify it. But if you modify it, then you can no longer call it S2C. It becomes your own made-up therapy, then… which is what we are suggesting that you do. Modify S2C to remove all vestiges of FC, including those inherited through RPM, and then subject that to research of quality.
Still not convinced? Then consider this…
The client is not required to lie down in order that gross motor planning won’t impoverish the resources needed for spelling. Neither are they directed to let their head freely loll about their neck, or let their jaw drop open. How does S2C explain this inconsistency? We don’t know. The S2C people have provided no answer for this flaw in their rationale. But look…
Even aside from the difference between superfine and fine motor planning, the client will be using speech that is conventionalized enough that it does not require the formulation of an entirely novel plan, so that speech would not impoverish the resources used to execute spelling. Not only that, there is a resource economy in the retrieval of multiple formal modes associated with a shared meaning. Plenty of solid therapy research recommends the promotion of multiple modes of expression.
S2C tells yet another story, one in which motor planning therapy works because it fosters “myelination.” That no doubt sounded like common sense to someone as well, but that’s simply not how myelin and myelination works.
So, to the degree that some people are interested in the development of S2C as a legitimate therapy with an evidence base, you have to drop the quackery. If you want to be different from FC, then you can’t keep stringing neurology buzzwords together to build up ad copy for some marketing ploy or other. That might sound harsh, but really, quit making stuff up.
If you want the respect of the community. then stop disrespecting all of their hard work. Stop making up these stories to pretend that you’re explaining what’s going on with S2C. You are only making it harder for any of us to figure out what there might be of value in the approach. Your appeal to pseudoscientific camouflage is preventing any benefit of S2C from being available to other people.
That is yet another way in which the facilitator’s needs (or those of the people selling S2C as a product) are being favored over those of anyone else.
So, when you find out what parts of S2C really work, and why, then you can use that knowledge to refine the therapy into a cleaner, more effective product.
And if the use of S2C really is about the needs of the client (about which we express no doubt), and not those of the facilitator (or those making money off of the product), then that improvement should be your goal. You should be striving to get rid of the portions that are quackery.
Are you willing to do that?
Because if you are, then many more people could potentially be helped.
And if you’re not, then please understand that you are choosing to deliberately hurt other people.
This is your autonomous decision to make.
[2024-04]
SLPS do not tend to categorize themselves as motor planning trainers (says the SLP), but that aspect exists.
Therapist
Resolution
Articulators
AKA
OT
fine
fingers, hands…
PT
gross
arms, legs, trunk…
Accuracy = How close did you come to the target?
Precision = How finely are you measuring?
The nature of the target matters. You can hit the broad side of a barn (accurate, imprecise). You can miss the eye of a needle (inaccurate, precise).
Vosseller no longer acknowledges any influence of RPM, or any direct experience with Mukhopadhyay. This is what is known as a sin of omission. She forgets her 2016 presentation at the RPM PD conference, where she said that she “began her journey with AEA and… RPM” in 2013; fortunately, the internet has a longer memory. She also didn’t count on the memory of the person who took her to be trained by Mukhopadhyay in 2013. This following post makes a very interesting read, and note the comment by Brooke Potthast (2016-10-26):
https://www.ageofautism.com/2021/10/spelling2communicate-y-e-s-or-n-o.html
Now, we know that any therapy can suffer from a bad practitioner. But this abuse is a part of the official program.