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Facilitators who work closely with individuals with autism, as well as other developmental disabilities (e.g., mental retardation, cerebral palsy, etc.) report that individuals with little or no language are fully expressive about life experiences, thoughts, feelings, choices, preferences, and decisions, when allowed to communicate through facilitation.

Biklen and other proponents of facilitated communication have been strongly opposed to objective, empirical validity testing. They maintain that testing undermines the individual's confidence, places him or her under pressure, and introduces negativism that destroys the communicative exchange.

Rather, under the surface of autism is a person with full cognitive faculties. Smith and Belcher (1993) indicate that much of this suggests a basic unwillingness on the part of families, professionals, and caregivers to accept the individuals with disabilities for what they are, thus diminishing the value of the individual in a way that the disability itself could not have.

A study published this week by Patricia Howlin of King’s College, London, reinforces this point. It suggests that as many as 30% of autistic people have some sort of savant-like capability in areas such as calculation or music.

Francesca Happé of King’s College, London, is one of them. As she observes, obsessional interests and repetitive behaviours would allow someone to practice, albeit inadvertently, whichever skill they were obsessed by. Malcolm Gladwell, in a book called “Outliers” which collated research done on outstanding people, suggested that anyone could become an expert in anything by practising for 10,000 hours. It would not be hard for an autistic individual to clock up that level of practice for the sort of skills, such as mathematical puzzles, that many neurotypicals would rapidly give up on.

Simon Baron-Cohen, a doyen of the field who works at Cambridge University, draws similar conclusions. He suggests the secret of becoming a savant is “hyper-systematising and hyper-attention to detail”. But he adds sensory hypersensitivity to the list. His team have shown one example of this using what is known as the Freiburg visual acuity and contrast test, which asks people to identify the gap in a letter “c” presented in four different orientations. Those on the autistic spectrum do significantly better at this than do neurotypicals. That might help explain Dr Happé’s observations about coins and raindrops.

For example, Smith et al16 studied 10 individuals with autism specifically to investigate the effects of facilitator influence and level of assistance on the results of FC. Each subject had six sessions, two with no help, two with partial assistance, and two with full assistance. Results showed that there were no cases of correct responses from the subject unless the facilitator knew the correct response. In addition, numerous responses were typed by the subjects to stimuli that were shown only to the facilitator, and not the subject. Similar results have been found by Regal et al17 and Eberlin et al.1

One complication of the use of FC has been the allegation of abuse, particularly sexual abuse, that has been obtained from individuals through the use of FC against third persons. This has generated adverse publicity and caused severely negative consequences for families who may be unsure of the validity of the allegations. Because of legal mandates regarding reports of child abuse, this becomes a critical issue for teachers and pediatricians alike, who may find the credibility of the report highly questionable but are obligated to fulfill their legal responsibilities. Margolin20 notes that although more than 50 such allegations have resulted in legal proceedings, most have terminated before trial. The ethical dilemmas posed by FC for practitioners have been reviewed by Jacobson et al.8

It is important for the pediatrician to obtain current data on both AIT and FC as they become available. Until further information is available, the use of these treatments does not appear warranted at this time, except within research protocols.

These results suggest that nonverbal children have specifically impaired imitation and pointing skills.

The NLP became synonymous with motivation and motivation is pivotal in teaching children with autism to respond to multiple questions.

1988 was the first time the word pivotal was used to describe this method. It was referred to previously as the NLP. It is considered a behavior intervention with similarities to the Lovaas method/ABA. 

Why would you say PRT is more effective than other therapies

The Utah researchers found that children receiving a combination of the two treatments (Lovaas-type training at school and TEACCH methods at home) showed three to four times greater progress on all outcome tests than did children who received only the school-based treatment. That study was reported in the Journal of Autism and Developmental Disorders (Vol. 28, No. 1, p. 2532).

Researchers in Washington, D.C., are comparing a discrete trial training approach with a "developmental, individual-difference, relationship based" (DIR) approach, says child psychiatrist Stanley Greenspan, MD, professor of psychiatry at George Washington University Medical School.

Psychologist Robert Koegel, PhD, at the University of California, Santa Barbara, and his colleagues are attempting to tailor a standard treatment to the specific needs of an autistic child and family. The standard treatment is called pivotal response training

This inclusion of substantially different disorders, with wildly different challenges, in one "spectrum" of disorders implies that the very serious challenges of persons with Autistic Disorder who lack a fundamental understanding of the world, who have very limited abstract thought and who have very little in the way of communication skills are somehow fundamentally similar to persons with good to excellent facilities in all these crucial areas of life.

Research is resulting in more and more people describing autism in the plural as autism disorders with different causes and different possible treatments.

It is time for the DSM to get realistic about the Autism "Spectrum".