Facilitated communication rsefers to a procedure in which a communication partner, called a facilitator, provides physical assistance to an individual with limited speech ability while that individual types out messages or selects letters, pictures, or symbols (Smith & Ryndak, 1996). Physical assistance includes support to the individual's hand or wrist and ideally is faded out over time by moving support from the hand or wrist to the arm, elbow, or shoulder (Smith & Ryndak, 1996). Proponents of facilitated communication have maintained that through this procedure, individuals with severe disabilities have been able to display unexpected levels of skills and abilities (Biklen, 1993). The asserted benefits of facilitated communication have contributed to the rapid growth of its use, not only in the United States but also in many other countries (Hudson, 1995).
In contrast to the growing popularity of facilitated communication, serious doubts have been raised from its very beginning concerning the authorship of the messages produced through this method (Prior & Cummins, 1992). These doubts have gained strength through several reported failures to validate authorship via controlled studies, in which the facilitator is unaware of the material presented to the person being facilitated. Thus far, reviewers have found some support for the claims of true authorship of messages conveyed through facilitated communication (Hudson, 1995; Mostert, 2001; Simpson & Myles, 1995). The support has come mostly from uncontrolled studies; studies using controlled procedures have generally refuted the validity of facilitated communication (Mostert, 2001; Simpson & Myles, 1995). At the present time, it is generally agreed that more controlled studies are needed (Ferguson & Horner, 1994; Mostert, 2001; Simpson & Myles, 1995). Typically, control of authorship is validated through message passing in which the facilitator is kept unaware of the information to be communicated. Nonexperimental methods of verification have also been defended as legitimate means for validating. The proposed methods include the analysis of typographical errors, differences in spelling, style and speed, and unusual expressions (Biklen, 1993).
Recently, Niemi and Kärnä-Lin (2002) have suggested refined linguistic analysis of texts as a new means of validation for facilitated communication. The analysis of the particular Finnish case that Niemi and Kärnä-Lin examined concentrated on clitic errors, inflectional errors, odd word order, the ending of sentences with verbs, special lexical features, and swear words. These characteristics of the texts in the case were contrasted with the typical Finnish use of language. On the basis of their linguistic analysis of this Finnish case, they concluded that “our results provide strong evidence for the claim that the text produced by facilitation originates from the author, not from the facilitator” (p. 355).
We think that several reported failures to show authorship in controlled studies should elicit sound caution toward cases in which success is claimed via noncontrolled means. This is especially true when complex communication is attributed to an individual who has significant disabilities, as in the case presented by Niemi and Kärnä-Lin (2002). Our study is a re-analysis of this case on the basis of material made publicly available for everyone. It provides one example of the way to do qualitative analysis on the validity of facilitated communication using multiple methods of validation. More specifically, it provides an investigation on the reliability of linguistic structural analysis in the validation of authorship.
The Case of Mr. Alatalo
In Finland, facilitated communication became widely known through the mass media in 1999, when a book by Alatalo was published by a major commercial publisher. It was purported to be written by a young man born in 1977, Tuomas Alatalo, who was diagnosed with severe cerebral palsy and mental retardation. The book, which contained, for the most part, autobiographical stories about the alleged writer, was nominated by Helsingin Sanomat, the leading daily newspaper in Finland, for an award for the best first work by an author. It received positive reviews in newspapers and magazines, and Alatalo appeared on some television programs. Even though the book did not win the award, Alatalo was still a target of interest and respect. He was a member of a jury in a writing contest, and in 1999, he was honored with the title “talent of the year,” awarded by the Finnish Mensa Society, an organization for people with exceptionally high intelligence (Finnish Broadcasting Company, 1999). Further texts published under the name of Alatalo have included columns in newspapers, Internet publications (Alatalo, 2002a), and the contribution of a chapter in a textbook for nurses (Alatalo, 2002b). Thus far, the true authorship of Mr. Alatalo's works has not been publicly challenged in Finland by any party.
According to the description found in Niemi and Kärnä-Lin (2002), the ability of Mr. Alatalo to control his movements is very limited, and he needs assistance with most of his daily activities. They stated that:
It is also extremely hard for him to move any part of his body intentionally if his position is not optimal for a particular type of movement. Yet, even in an optimal position, involuntary movements often prevent him from continuing even such typically automatic activities as swallowing and biting. (p. 348)
According to their description “his main means of communication were a few spoken words (e.g., äiti [mother], arkku for Markku—his father's first name, ope [teacher]) and some facial expressions” (p. 348).
Data and Data Analysis
The data on which our analysis is based include three published texts attributed to Alatalo (Alatalo, 1999, 2002a, 2002b), his interview in Helsingin Sanomat (Kiiskinen, 2000), a 49-minute taped television program on Alatalo (Itkonen, 1999), a preface by a child psychiatrist to the book attributed to Alatalo (Sinkkonen, 1999), and the study of Niemi and Kärnä-Lin (2002).
The analysis of the authorship of Mr. Alatalo was based on a multiple criterion approach. The ordering of the validation criteria was as follows. The first task was to seek documentation on the actual process of facilitation. If the level of physical support was so minimal that it warranted independent writing, authorship would not be questioned. If not, the next question would concern eye-focus when writing. If there was eye-focus, our third task was to seek controlled evidence on success in the delivery of information that was unknown to the facilitator. This testing should also cover reading ability. If these criteria were fulfilled, authorship would be validated at least to the extent of the examined material. Additional criteria to be considered would be uncontrolled evidence on information delivered that was unfamiliar to the facilitator, age- and gender-appropriateness of produced texts, and variability in the quality of texts between facilitators. These additional criteria alone were not considered to be sufficient in themselves, but they could be used in the partial validation of authorship of particular texts if the main criteria were fulfilled.
Outcomes of Authorship Analysis
Level of Independence in Writing
If the assistance given in facilitated communication is so minimal that it makes it impossible for the facilitator to write on behalf of the person facilitated, question of authorship never rises. Biklen (1993, p. 130) mentioned several cases in which facilitated communication has been successfully faded so that authorship has become unquestionable. Niemi and Kärnä-Lin (2002) reported that Mr. Alatalo was at first, in 1993, supported from the palm of his hand so that his index finger was isolated for pointing. According to them, “in about a year, the physical support was moved from the palm to his elbow” (p. 348). At the time of their study, this form of support was noted to be still continuing.
The reported data of Niemi and Kärnä-Lin (2002) did not contain any observation of authentic typing by Mr. Alatalo. In Palatal's (1999) book, the facilitation process was described very superficially. However, the 49-minute television program (Itkonen, 1999) contained a short clip of about 30 seconds on the facilitation in practice. In the program the facilitator was not Mr. Alatalo's mother but a female assistant. During the 30-second clip, the facilitator held the left forearm of the writer, right beneath his wrist, with her right hand so that the supporting hand of the facilitator went below the elbow of the writer. The hand was not supported from the elbow, as stated by Niemi and Kärnä-Lin (2002), but from the forearm. Most of the time the facilitator used both of her hands so that her left hand also supported the writer at the forearm. Thus, the facilitator held the arm with both hands like a hammer. The fingers and wrist of Mr. Alatalo were stiff and the fingers straight. Typing did not occur with the index finger as stated by Niemi and Kärnä-Lin (2002) but with the middle finger. In Alatalo (2002a), he stated that the facilitator “holds my wrist,” which is in accordance with the presentation shown on television, but not with the description found in Niemi and Kärnä-Lin (2002).
The television program included a segment in which Mr. Alatalo was given a series of questions. His answers were prerecorded at home and were then reproduced in the studio from the memory of the writing machine. The host of the program said that this was done in order to save time because the typing occurred so slowly. However, it looked like the program had one instance of authentic facilitated writing done live in the studio. In this part of the show, Mr. Alatalo was shown to write: “Thank you that I was allowed to come to this program” (Itkonen, 1999). With repeated rewinding of the tape, however, it became obvious that even this section could not have happened in real time. There were only 12 keys typed while the entire sentence needs 38 keys when typed in Finnish. Also, the keys typed and the consecutive words coming from the speaker of the machine were not in tune with each other. It was clear that this section was also prerecorded either at home or in the studio. Thus, TV viewers were made to believe that what they saw was authentic writing, whereas, in fact, they were misguided by a simple trick. The only outside description of real time typing in the data is presented by Kiiskinen (2000), who stated that “mother does not guide the hand of Tuomas even if it looks as if she does” (p. 55).
The way Mr. Alatalo was facilitated made it entirely possible for a facilitator to do the typing. Because Mr. Alatalo's fingers and wrist were stiff and his fingers were also straight, it was even possible to control the typing even if support had been given only at the elbow, as anybody can attest to if they try to do the same.
Another important question concerning independent writing is whether the person looks at the keyboard when typing. In the television program, at times Mr. Alatalo looked at the keyboard when typing and at times he did not. The facilitator, however, looked intensively at the keyboard. Alatalo's mother explained that writing did not necessitate eye focus on the keyboard, and this is also confirmed in the book attributed to Alatalo, in which it is stated that: “People always wonder when they watch me type how it is possible that I do not look at the keyboard at all and, in spite of this, hit all the right letters.” (Alatalo, 1999, p. 53). Besides looking elsewhere, Mr. Alatalo also speaks while typing: “How do I write long sentences, even when I babble on about other things, and at the same time look around all the time and not on the keyboard?” (Alatalo, 1999, p. 54). This behavior was explained in the following way: “Maybe hard experiences and suspicions towards my writing made me defiant, and I wanted to make the writing situation look really freaky” (p. 54). The ability to write without looking at the keyboard was explained by exceptional vision: “My vision is unbeatably good. With only one very rapid glance, for instance, I can read a page of a book” (p. 54).
It is obvious that writing accurately with one finger in the air and no reference to the keyboard is simply impossible. Anyone is easily convinced of this by trying to do so. Therefore, it should be clear on the basis of the above description that Mr. Alatalo has not written the texts attributed to him.
The case could well be closed here. However, there are many other criteria that could also be applied when considering the validation of facilitated communication. From this point on, we continue the analysis, not in order to make the conclusion any stronger, but in order to provide an example for the use of multiple methods in the analysis of authorship.
Reading ability is a necessary prerequisite for communication through typing. In our data we found no reliable documentation on the reading ability of Mr. Alatalo. Instead, it was said that his mother read to him (Alatalo, 1999, p. 17) or he listened to taperecorded stories (p. 87). There was no kind of evidence that Mr. Alatalo read on his own, even if it was reported that Alatalo was able to read whole pages at just a glance (p. 54). Alatalo's book is full of similar inconsistencies. The only description of the verification of Mr. Alatalo's reading ability is reported by Kiiskinen (2000) and based on an interview with his mother. According to his mother's statement in the interview:
When they drove past an ice cream stand Tuomas made a gesture of eating ice cream and there were no more doubts concerning his reading ability. Because the ice cream stand did not look like one. Tuomas had read the sign. (p. 55)
One wonders what the gesture of eating ice cream looks like, and how it differs from other gestures with different meanings.
Controlled Message Passing
Our fourth question was whether there had been any attempts at controlled verification of authorship in the case of Mr. Alatalo. The answer is yes. The book contains descriptions of two blind tests on authorship in which his mother was the facilitator (Alatalo, 1999, pp. 52–53). Both of these tests failed in that a message unknown to the facilitator was not delivered. The second test seemed to be planned especially to take into consideration the expressed need for a safe environment and trusted facilitator: A video was presented at school, and Mr. Alatalo had to write about its contents at home with his mother. It was possible that there were other tests, too. In an interview with Kiiskinen (2000), the mother only referred to “humiliating” tests with suspicious and hostile facilitators.
Nonexperimental analysis concerning the textual content credited to Mr. Alatalo indicated that stories turn very brief when life events are described in which the mother is not present, as in the section describing a 2-year stay in a boarding school far from home during the years 1995 through1997, which were completed just one year before the book was finished. This section is written about in detail only in the description of the opening ceremonies, but otherwise, 2 years of Alatalo's life is summarized very shortly. The description of these years almost remains at the level of a passing comment: “Of course, many events occurred in two years” (p. 46).
Age-appropriateness of the text provides another additional criterion. As many reviewers of the texts attributed to Mr. Alatalo have admitted, the content of the texts are exceptionally mature when compared with the age of the alleged writer (Kiiskinen, 2000; Sinkkonen, 1999). Gender-appropriateness of the text is threatened in a fragment where the (male) writer described sexual excitement as follows: “A small irritating feeling from inside announces: be careful that the pants don't get wet” (Alatalo, 1999, p. 125).
In Alatalo's book, many exceptional abilities have been attributed to him in order to explain the content of produced texts or in order to apologize for features of his behavior. Written memories of Mr. Alatalo in his book extend to the time when he was 5 months old (Alatalo, 1999, p. 24). This indicates a lack of childhood amnesia at an age that is not known to the science of psychology. For instance, Bruce, Dolan, and Phillips-Grant (2000) concluded on the basis of reviewed research that the earliest personal memories of adults date back to somewhere between 3 and 4 years of age. Early childhood memories for Mr. Alatalo are explained through the phenomenon of photographic memory (p. 33). Mr. Alatalo has been said to possess an “unexplainably wide memory” (p. 197). Exceptional mental properties are also used to explain his odd behavior. An example of this is his lack of eye contact, which is explained by an ability to get much information from a person just by a rapid look at his eyes (p. 115). Further, failure to do training school tasks is explained away by boredom because the tasks were too easy (p. 87); failure in testing situations is explained by his difficulty in remembering things that have happened only moments before (p. 52); and yelling is attributed to his exceptionally sensitive hearing ability, which was, however, not documented in his neurological case records (Niemi & Kärnä-Lin, 2002). However, Mr. Alatalo used a hearing-aid in both ears in the television program and in the newspaper interview.
Finally, there is a question concerning differences in textual content between different facilitators. In the end, only his mother was accepted as a true facilitator. Eero, a male assistant, was reported to be the second choice, but even he remained far behind the mother: “I would like to write with the help of Eero, but my will is prevented by emotion” (p. 49). There was indeed a large discrepancy in the quality of expression between the main components of the book (Alatalo, 1999) and some textual fragments found in the same book, but facilitated by someone other than his mother.
Validation of Facilitated Communication as a Social Process
In light of the preceding evidence, the question must be raised of how it was ever possible for the true authorship of Mr. Alatalo to be so unanimously accepted by the public. This case can be used as a cautionary example of the process of validation of facilitated communication that happens in the absence of any sound reasoning.
In the beginning, many professionals in the field actually came up with serious doubts on the originality of the texts (Alatalo, 1999; Itkonen, 1999). However, the mother met these doubts by actively seeking any professionals who would be ready to support her stance (Alatalo, 1999, p. 41). When a well-known child psychiatrist was ready to vouch for the true authorship of Mr. Alatalo concerning the texts attributed to him, the way was opened for the media to accept the phenomenon as it was interpreted to them. Professional skepticism was presented as something already dealt with that belonged to the past, while in reality the professionals who knew the case were probably bound to a professional code of silence.
This story stresses the central role and responsibility of some key professionals who, on the basis of weak reasoning, accepted the authorship of Mr. Alatalo. The actual evidence that led the well-known child psychiatrist to vouch for Alatalo's authorship was explained as follows:
When I looked into the eyes of Tuomas, there could be no question that before me was an intelligent, feeling and experiencing persona. A bond was formed between us and I felt the bond more important than the question of the authenticity of the writings of Tuomas. (Sinkkonen, 1999. p. 6)
For additional verification, Sinkkonen (1999) referred to original words and neologisms in the texts attributed to Mr. Alatalo.
Reliability of Linguistic Structural Analysis in the Validation of Facilitated Communication
In this case study, the authorship of Mr. Alatalo was rejected on the basis of dual criterion. The level of physical assistance provided made it possible for the facilitator to type the words on behalf of Mr. Alatalo and, at the same time, the lack of eye focus by Mr. Alatalo on the writing made it impossible for him to be the author. In the present case, these two criteria together form a sufficient basis for rejection of authorship. In order for true authorship in facilitated communication to be validated, it is also essential that the individual, under controlled conditions, be able to deliver information that is unknown to the facilitator. In the case of written output, it is also important to show that the person facilitated has an ability to read. Other, supplementary criteria can also be applied, as was done in this study. In the present case we could not find any support at all for the authorship of Mr. Alatalo.
Ferguson and Horner (1994) stated: “Without clear demonstration that authorship comes from the person with disabilities, all other issues around facilitated communication are muted” (p. 305). Therefore, the endeavor of Niemi and Kärnä-Lin (2002) at linguistic structural analysis on the texts credited to Mr. Alatalo can be regarded as too hastily made. In their article they accepted the true authorship of Mr. Alatalo without telling why they did so. They interpreted the results of their linguistic analysis as providing further evidence for authorship. However, because the re-analysis of the case indicated that Mr. Alatalo could not be the writer of the texts attributed to him, the linguistic structural analysis used as a means of validating these texts also failed. Independent of the results of this re-analysis, we note that Niemi and Kärnä-Lin made an error in concluding that the unusual linguistic structure of the texts would validate authorship. Their conclusion is inadequate, first, because anyone capable of using language can also use odd linguistic structures at will, and second, it remains a mere supposition that the style of Mr. Alatalo is peculiar in so far as we have no independent means to verify this.
Actually, it is quite easy to interpret the linguistic peculiarities presented by Niemi and Kärnä-Lin (2002) as consequences stemming from errors made by the facilitator. When a typing “error” occurs, the facilitator is still able to end up with an acceptable sentence if he or she is ready to break some linguistic rules or conventions. The alternative explanation for the results of Niemi and Kärnä-Lin (2002) is as simple as that.
In order to avoid going down similar wrong tracks in the future, it is essential to take the recommendations of Cardinal (cited in Biklen, 2002) seriously:
A systematic, scientific, and rational protocol for the investigation of authorship in facilitated communication must be developed.. We need to share protocol conditions with journal editors and promote standards for demonstrating protocol conditions for authorship studies. (p. 2)
With the help of these kinds of standards, it should be possible to agree on authorship issues before more refined analyses are conducted on any other facets where true authorship is presumed.
Author: Timo Saloviita, PhD, Professor ( firstname.lastname@example.org), Department of Teacher Education, PO Box 35, FIN-40014 University of Jyväskylä, Jyväskylä, Finland. Heikki Sariola, MSc, Researcher, Central Union for Child Welfare in Finland, Armfeltintie 1, 00150 Helsinki