No evidence Autism treatment Rapid Prompting Method works

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ASPartOfMe
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15 Aug 2019, 8:23 am

Analysis finds no evidence for popular autism communication method

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A comprehensive review has found no scientific basis for a controversial technique that supposedly helps autistic people communicate1.

In the ‘rapid prompting method,’ a person trained in the technique holds an alphabet board or a tablet and, using words or gestures, prompts an autistic person to point to or tap letters, words or pictures.

The method resembles a discredited technique, called facilitated communication, in which a person applies pressure to the hand or arm of an autistic person to help her share her thoughts via a board or tablet. A string of rigorous studies, dating back to the 1990s, has shown that messages created by facilitated communication are almost always controlled by the facilitator — sometimes with harmful consequences.

Rapid prompting also requires the help of another person, although unlike in facilitated communication, the helper does not physically apply pressure.

Given the similarities between the two techniques, however, experts have long urged caution against using the rapid prompting method until its safety, validity and effectiveness are proven. It is possible, they say, that the facilitator influences the messages — intentionally or not — by moving the communication device or through subtle cues.

Soma Mukhopadhyay, the mother of a nonverbal man with autism, created the rapid prompting method for her son nearly 30 years ago and has since taught it to hundreds of others. Experts say they are troubled that the method has gained traction among families and in schools.

“It’s all being used on the basis of anecdotal evidence and zero science, according to this review,” says Pat Mirenda, professor of educational and counselling psychology and special education at the University of British Columbia in Vancouver, Canada, who was not involved in the study. “That’s really problematic.”

Roughly one in four autistic people speaks few or no words. To help these people express themselves, speech-language pathologists often use augmentative and alternative communication. This type of therapy includes any of various tools and methods designed to stand in for or supplement speech — such as the speech generator that responded to cheek twitches from the late physicist Stephen Hawking.

Unlike rapid prompting and facilitated communication, these tools do not require a facilitator and lead to independent communication, and professional organizations such as the American Speech-Hearing-Language Association support their use.

Schlosser and his colleagues scoured scientific databases for studies of the effectiveness of the rapid prompting method for autistic people. They found 108 studies that mention the method, but none met their criteria for a valid test of a therapy. They reported their results in May in the Review Journal of Autism and Developmental Disorders.

“There’s no scientific validity to [rapid prompting],” says Diane Paul, director of clinical issues in speech-language pathology at the American Speech-Hearing-Language Association, who was not involved in the study. “It hasn’t been demonstrated to lead to independent communication, and it’s very prompt-dependent.”

Paul says an early version of the new study led her association to recommend against the use of rapid prompting, in a policy statement released August 2018. The American Association on Intellectual and Developmental Disabilities also disavows the technique.

The new study “meets the highest standard” of scientific rigor, says Oliver Wendt, assistant professor of communication sciences and disorders at the University of Central Florida in Orlando, who was not involved in the work. “There should be many more experimental studies on the rapid prompting method.”

Wendt, Schlosser and others acknowledge that the lack of evidence does not mean the method is ineffective. Rather, the findings highlight the need for studies to determine who generates the messages produced during rapid prompting. If those studies suggest that the method reliably relays the thoughts of the autistic person rather than of the facilitator, the experts say, the next step would be to test whether the technique improves the autistic person’s communication skills.


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BenderRodriguez
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15 Aug 2019, 8:29 am

Maybe poking with a stick will work better :roll:


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23 Aug 2019, 1:59 am

The article is in Spectrum News. A comment on the article by one Lisa Keller says:

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There are no end of serious flaws in this article, beginning with the statement that RPM relies on a communication partner who holds the letterboard while the autistic person spells. Many who use RPM do so by independently pointing to a keyboard that is mounted on a table, with no input from a partner. Another assertion was made that "rigorous studies" were done on FC in the 1990's. These studies were highly flawed: the people conducting the experiment were given 30 minutes of training in FC, and had no familiarity with the typer. whom they supported. Also, many of the answers were rejected for minor spelling or semantic errors (e.g., quite for quiet, truck for tractor), and several other answers were correct.
But the most egregious statement involves ASHA's Diane Paul citing a "new study" that points to the lack of validity in RPM. ASHA knowingly based their decision to oppose RPM and FC on this study, when in fact the study was retracted for serious ethical violations. The details of those violations are on United for Communication Choice (https://unitedforcommunicationchoice.org/), under Letter fo ASHA.

I, myself, was conducting a quantitative study on FC in 2017. The study was collecting objective measurements on level of communication complexity and level of support, and demonstrating the hypothesis that autistics' movement disorders could be mitigated by the use of decreasing physical support. The study was abandoned by The Lurie Center for Autism because of opposition. Its opponents argued that TLC should not be supporting a technique that was not evidence-based, despite the fact that evidence was being collected! Imagine the outcry if other studies were stopped for that reason.

Please do due diligence and actually observe a number of people who type using either technique. If you see even one person who types with no support (and there are hundreds of people doing so), you cannot state that it is not valid.

Lisa Keller, MS, CCC-SLP
President, Autism National Committee (AutCom)


The author of the article, Nicholette Zeliadt, then replied to Lisa Keller as follows:

Quote:
Please note that above article states: "Paul says an early version of the new study led her association to recommend against the use of rapid prompting, in a policy statement released August 2018." By 'new study' we are referring to the published systematic review by Schlosser et al., which has not been retracted.


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naturalplastic
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23 Aug 2019, 6:42 am

I remember Sixty Minutes stories about "Facilitated Communication" back in the Nineties.

The theory behind FC sounds like pure BS, but it looked like a miracle when demonstrated on TV.

But FC was thoroughly discredited. It turned out that it didn't just seem like BS. It WAS BS. And was discarded into the trash heap.

Apparently that mom of that autistic child independently invented this similar technique for use on her own child at about that same time in the 90's, and apparently it caught on as a fad treatment in the 2000s, and is still widespread. Never before heard of it.

I wish they would explain better how Rapid Prompting supposedly works. FC involves a trained adult actually holding the child's arms and responding the child by lifting the child's hands to touch the sheet, or screen, with the letters. This similar technique somehow doesn't involve touching the child, but does involve a second person somehow picking up on the child's cues.



magz
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23 Aug 2019, 7:43 am

Quote:
“There should be many more experimental studies on the rapid prompting method.”

Wendt, Schlosser and others acknowledge that the lack of evidence does not mean the method is ineffective. Rather, the findings highlight the need for studies to determine who generates the messages produced during rapid prompting. If those studies suggest that the method reliably relays the thoughts of the autistic person rather than of the facilitator, the experts say, the next step would be to test whether the technique improves the autistic person’s communication skills.
I was rather surprised that rp evaded being experimentally tested for so long.


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naturalplastic
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23 Aug 2019, 8:46 am

From U tube vids apparently the therapist prompts the child with questions, and the child takes a pencil and pokes the letters that spell out the answer. Typically they use a stencil sheet (in which the letters are cut out of the plastic) of the alphabet so that the child can "feel" as well as see the letter being picked. Other than the fact that the child does all of the physical work of picking the letter it does look a lot like facilitated communication. But there is less of a fudge factor because the therapist is not holding the kids arms, so there isn't that danger that the therapist is making the picks for the child (Consciously or unconsciously). But still. There still could be fudge factors.

And yeah. After almost 20 years its about time that someone tested it under controlled conditions!



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23 Aug 2019, 8:48 am

The fact that the autistic people in the 1990s had the cognition even to "heed the suggestions" of the therapists---through Facilitated Communication--means that these autistic people probably had a more intact cognition than most people thought.



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27 Aug 2019, 2:57 am

kraftiekortie wrote:
The fact that the autistic people in the 1990s had the cognition even to "heed the suggestions" of the therapists---through Facilitated Communication--means that these autistic people probably had a more intact cognition than most people thought.



... That's a sad fact about humans: humans have feelings, so we often can't make rational judgment. Even when rational thinking tells us one thing, we would still choose to delay facing it. Frankly, myself still have this defect. You know it, but you still want to take your chances. That's why love cheats succeed at scoring. Like myself, I have a fairly high IQ, and my probability estimates are also fairly accurate, from my experience, I can roughly estimate the probability of an event. However, when the probability of ocurrence is low, I often get myself into the same trap, choosing to believe that, he was just unlucky. We often go in denial. The reality is something else. My dear child, the probability of you being an exception is very low. Therefore, next time you encounter something unusual, I am afraid you still need to accept reality: that it has issues. Don't try to use outliers of the normal distribution to deceive yourself. That's why we talk about null hypothesis. What I mean is, when a normal distribution shows up at its outlier region, try to avoid saying that it is still the same mechanism but only that it falls on the fringes... because the true mechanism may be something else altogether. When the probability is low, you need to tread carefully, because it's a whole different mechanism. Knowing all this, I often still make the same mistake. That's a sad fact about humans: because humans have feelings, Humans have expectations. Even though I myself often make this mistake, I would still encourage myself and all of you, that we all should have the courage, based on mathematical logic, to tell ourselves: "it's probably not the case." You often choose to believe, because you have expectations. ...

- - -

There is a difference between having reasoning skills, and being a chatbot. A chatbot provides answers based on statistical correlations: it's "weak AI." True reasoning skills is "strong AI." Unfortunately, the level of intelligence achieved by RPM users seems to fall into the chatbot category.


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