Social Constructivism, Positivism, and Facilitated Communication

Grover J. Whitehurst & Deanne A. Crone

State University of New York at Stony Brook

Running head: Social Constructivism, Positivism, and Facilitated Communication Published in The Journal of the Association of Persons with Severe Handicaps, 1994, 19, 191-195.

Preparation of this article was supported by grants to G. J. Whitehurst from the Pew Charitable Trusts (91-01249-000), and the U.S. Administration for Children and Families (90CD095701 & 90CD096201). Views expressed herein are the authors and have not been cleared by the grantors. Requests for reprints and inquiries can be addressed to G. J. Whitehurst, Department of Psychology, SUNY, Stony Brook, NY 11794-2500 (e-mail russ@psych1.psy.sunysb.edu) .

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Social Constructivism, Positivism, and Facilitated Communication Abstract Facilitated communication, a technique that is said to enhance the communicative abilities of individuals with severe language impairments, has engendered much controversy. Biklen and Duchan (1994) and Green and Shane (1994) present two sides of this controversy. Biklen and Duchan argue that from a constructivist's perspective, the primary issue is the underlying cultural presuppositions regarding mental retardation and science rather than the efficacy of facilitated communication. Green and Shane present research evidence challenging the efficacy of facilitated communication within a positivist's framework. We present a brief review of science as viewed through positivists' and constructivists' lenses. Using the framework of social constructivism adopted by Biklen and Duchan, we disagree with them on three points: 1) even though the process of constructing scientific knowledge is strongly affected by human social, emotional, and cognitive processes, it also involves matters of fact that cannot be ignored; 2) social constructivists' accounts of science can be accepted as descriptive without being prescriptive; 3) while we cannot prove that belief systems, including positivism and social constructivism, are true or false in the larger sense, belief systems have differential consequences for technological changes of the type that are valued by persons with severe impairments of communication.

Page 2 Facilitated communication is a procedure that is said to enhance the communicative abilities of persons with severe impairments in typical modes of oral or written language, particularly individuals diagnosed with autism or intellectual retardation. Typically, a communicatively normal adult, the facilitator, supports the wrist or arm of the person with the communicative deficiency as that person generates messages by selecting letters from a letter board or special typewriter. Advocates of facilitated communication have attributed remarkable improvements in the ability to communicate by people with severe communicative impairments to this procedure (e.g., Biklen, 1993; Crossley, 1992). In a characteristic case report (Biklen, 1990), Jonothan, a 7-year-old described as autistic, incontinent, and without any history of expressive language, reportedly began typing messages in the first few minutes of exposure to facilitated communication: "Crossley managed to settle Jonothan on her sofa .... She typed 'JONOTHAN,' followed by 'MUM,' and then asked him for 'Dad.' He went straight to the D .... She typed 'JONATHAN,' whereupon he [with Crossley holding his hand] typed 'JONOTHAN.' Crossley later checked the spelling with his mother. Jonothan had been correct" (p. 294). In a later interaction, Jonothan reportedly typed a message about someone having sat on him and was asked by Biklen whether he meant that literally or metaphorically. "Jonothan [with Crossley holding his hand] responded by typing 'MET'" (p. 292). That literacy would emerge spontaneously in anyone and then be applied to abstract semantic distinctions such as "metaphorical" is remarkable. It is even more remarkable that such a phenomenon would occur with an otherwise low functioning 7-year-old. In normally developing children, the ability to understand grapheme-phoneme correspondences (e.g., that the word "Dad" starts with the /d/ sound which corresponds to the letter D) and the ability to translate that knowledge into print typically requires instruction at home and/or at school and proceeds along a

Page 3 regular and gradual course (Adams, 1990). The sudden emergence of these abilities in people labeled autistic or retarded would represent a critically important therapeutic breakthrough as well as a significant challenge to theories of autism, retardation, and literacy acquisition. The use of facilitated communication with communicatively impaired populations has burgeoned in the United States, perhaps due to the presentation of dramatic case histories by Biklen (1990), Crossley (1992) and others. Controversy over its meaning and effectiveness has gone hand in hand with its increased implementation. In an effort to present both sides of this controversy, the editors of this journal asked Biklen and Duchan (1994) and Green and Shane (1994) to respond to 10 questions concerning facilitated communication, such as "Under what conditions ... might facilitated communication work and what evidence is available?" These authors were apt choices as Biklen has been the major advocate for facilitated communication in the United States, and Green has generated the largest body of research questioning its efficacy. We considered ourselves reasonable choices as commentators on their papers. Our basic research on the development of children's communication skills (e.g., Sonnenschein & Whitehurst, 1984) and our applied research on interventions for language delay (e.g., Whitehurst, et al., 1991; Whitehurst et al., 1994; Whitehurst & Fischel, 1994) is similar enough to the subject matter of facilitated communication to allow us a basis for evaluating competing claims. At the same time our work has never involved the severely impaired, nor do we know or have any connection with the principals in the controversy. Thus we looked forward to sorting through the answers to the questions posed by the editors with what we hoped would be both an absence of interfering bias and the perception of neutrality. As it turned out, Green and Shane hued closely to the task set by the editors, while Biklen and Duchan chose instead to argue that the editors' questions were invalid: "the controversy ... is not just about whether particular individuals are authoring their own messages, nor is it about whether the

Page 4 method is successful or not. It is not about what percentage of people can be proven competent, or about the percentage who have achieved or will achieve independent typing" (Biklen & Duchan, 1994, p. 34-35). Questions such as these are said by Biklen and Duchan to reflect "a positivist perspective, implying that there are objective truths about facilitated communication that can be discovered through research studies" (p. 22). Biklen and Duchan take the position that they are practicing a different type of science, one incommensurate with questions concerning objective truths about facilitated communication. This type of science, called social constructivism (and conflated by Biklen and Duchan with other descriptors such as competence-based, phenomenological, experiential, ethnographic, and interpretivist), is said to lead to questions, methods, and answers that are different from those of positivists' science, and equally valid, e.g., "Our aim in this article is to provide convincing evidence to show that mental retardation does not exist as fact separate from interpretation ...." (p.2). Before detailing our disagreement with Biklen and Duchan's interpretation of social constructivism and its relevance for basic issues concerning facilitated communication, we note several points on which they and we are of like minds: 1) People with mental retardation should be treated with respect as individuals. 2) It is important to consider individuals' competencies as well as their deficiencies. 3) Labeling a person as retarded has repercussions on that person's life circumstances. 4) If an individual has the cognitive ability to communicate, but does not possess the necessary motoric skills, that person should be assisted by any valid means to express his/her thoughts and feelings. 5) Individuals involved in a discourse influence each other. 6) Data should be collected across time and under different circumstances for the same individual in order to produce an accurate assessment of that person's abilities and deficits. 7) It is interesting and important to determine how people with severe communicative impairments interpret their experience. 8) Data

Page 5 collected in natural circumstances can present a different view than data collected in highly controlled circumstances. 9) Ethnographic, qualitative research can be extremely useful in allowing scientists to formulate the intuitions and hypotheses that are a critical prerequisite to the most creative controlled research. 10) People without advanced degrees or special credentials can be trained to provide effective services for people with special needs. We have no particular bias regarding the efficacy or importance of facilitated communication. The research reviewed by Green and Shane seems to us to present a strong negative case for the general efficacy of the procedure, but we think the possibility of facilitated communication being useful in occasional specific cases is not entirely foreclosed and should be the topic of continued research. We do however have strong views about philosophy and research on social constructivism and its relevance to the evaluation of claims that are said to be scientific. Biklen and Duchan have

used tenets of social constructivism to legitimize their claim that the utility and validity of facilitated communication need not be evaluated. They have attempted to refocus debate on the issue of the We will attempt to place social

cultural presuppositions underlying mental retardation.

constructivism in the context of the scientific enterprise and explain why Biklen and Duchan have misused it. In doing so we have been influenced by the work of our colleague, Stephen Cole (1992), who views the larger philosophical issue, of which social constructivism is one variant, as being able to account for consensus in science. That is, why do scientists come to agree that certain theories or claims of fact are justified and others are not? In the traditional positivists' view that is held by nearly all working scientists, science consists of claims about matters of fact. Scientists who wish to contribute to the body of knowledge that represents their discipline submit the results of their work to a process of peer review in which agreed upon criteria for publication are applied. These criteria consist of a set of clear rules for

Page 6 judging the procedural adequacy of the research and more fuzzy judgments regarding the work's importance. Given that the application of these criteria is subject to ordinary human frailties, mistakes are expected to occur. These include false claims of fact that are published, true claims of fact that are rejected, and the publication of work that is trivial. Mistakes at the level of publication are corrected by a second and more stringent evaluation occurring at the level of the audience of scientists to whom the published work should be relevant. The massive volume of published research in almost all fields of science is winnowed by the process of selective citation in subsequent research efforts. The net effect is cumulative science: The false or trivial research falls by the wayside, while the valid and important claims of fact become part of the enduring core. The last 50 years have witnessed a sustained attack on the positivists' view of science by philosophers and other critics. Though the arguments against positivism may vary, at the core of each is an appreciation of the degree to which science is a product of human cognitive, social, and emotional processes. The net effect is an acknowledgment that scientists, unlike Spock, are not perfectly rational beings. Instead they are involved and invested in a process of making meaning from their data and successes of their careers. At the least, this means that scientific theories and the degree of allegiance they engender are not completely dependent on observationally reliable facts. For instance, Lakatos (1970, p. 70) argued that observations (i.e., facts) in science are always theory laden: Galileo claimed that he could "observe" mountains on the moon and spots on the sun and that these "observations" refuted the time-honoured theory that celestial bodies are faultless crystal balls. But his "observations" were not "observational" in the sense of

being observed by the -- unaided -- senses: Their reliability depended on the reliability of his telescope -- and of the optical theory of the telescope -- which was violently questioned by his contemporaries. In a similar vein, Kuhn (1962) held that science is not cumulative. New approaches are simply

Page 7 different rather than better than the ones they replace. In fact, according to Kuhn, objective truth plays no role in the evaluation of theories or paradigms. He notes that when Newton first published the inverse square law and his calculation from it of the predicted motion of the moon at perigee, the motion that could be observed with available methods was only half that predicted. Yet the theory was generally accepted during the 60 years that passed until the observational data caught up to it. In addition to philosophical writings, there is research that demonstrates the extent of irrationality in the scientific process. For example, a large and consistent body of work shows that consensus among reviewers of manuscripts submitted to prestigious journals or the National Science Foundation is relatively low (e.g., Whitehurst, 1984, Cole, Cole, & Simon, 1981). In one particularly revealing study, 12 already published research articles were resubmitted to the original journals a year or so later with fictitious authors and institutions, but otherwise unaltered (Peters & Ceci, 1982). Of the nine articles that were not detected as resubmissions by journal editors, eight were eventually rejected. In many cases the grounds given for rejection were described as "serious methodological flaws." As the argument goes, if science were a rational enterprise, firmly grounded in matters of fact, results such as these would be impossible. A final research and theoretical influence that has played a key role in the development of social constructivism is the theory of Piaget (1976, p. 13), who holds that objective knowledge structures "are the result of a construction and are not given in the objects, since they are dependent on action, nor in the subject, since the subject must learn how to coordinate his actions ..." This is the principal hypothesis of social constructivism, that learners construct their knowledge of the external world and this knowledge depends as much on learners' physical and mental actions as on the external world. Evidence supporting Piaget's position takes the form of demonstrating that individuals will fail to acquire certain specific concepts despite adequate teaching or exposure unless their general state of

Page 8 cognitive development allows those specific concepts to be assimilated. For instance, Lawson et al. (1991) demonstrated that skill at hypothetic-deductive reasoning rather than age predicted whether high school students could learn particular classification tasks that involved systematically testing alternative hypotheses about class membership. There are many problems with the types of evidence that have been presented in support of the contructivists' view. For instance, the low reliability in peer review may be an artifact of the statistical procedures that are applied to measure it (Whitehurst, 1984), and the claims of close links between Piagetian stages of development and the learning of specific tasks have been seriously challenged (Brainerd, 1978). However, suppose we accept the claims or implications of social constructivism that flow from the material we have briefly reviewed: 1) the history of science includes many instances in which ideas and theories have had far more influence on generating scientific consensus than have observable facts; 2) the history of science can as often be characterized as due to the theoretical equivalent of fad and fancy as to the relentless forward march of cumulative knowledge; 3) the procedures for judging the worth of contemporary research at the level of peer review are filled with caprice; and 4) the construction of human knowledge depends as much on actions of the learner as on the external world. Even so, does it follow that Biklen and Duchan, or indeed anybody who wishes to cloak their work in the mantle of science, can reasonably take the position that they need not address matters of fact because there are no objective truths that can be discovered through research? We think the answer is clearly no, for three reasons. First, the only thing that the empirical, philosophical, and historical analyses of social constructivists demonstrate, if taken at face value, is that human processes that are not grounded in matters of fact or the formal rules of science have a very significant impact on the products of science. However, such a demonstration does not exclude a separate or interacting role for reality,

Page 9 nature, or objective truth in the production of scientific consensus, either logically or empirically. Certainly in Piaget's theory, which is a touchstone of constructivists' thinking, knowledge emerges as a joint product of the learner and the object. Cole (1992, p. 25) describes the necessary role of empirical facts in science as follows: Even though in some 'ultimate' sense there may be no way to determine whether one paradigm is a better approximation to the 'real' laws of nature than another, the exclusion of nature and the empirical world from our model of how scientific knowledge grows makes it difficult to understand why some knowledge enters the core and most does not.... [Consider HIV and AIDS.] If a vaccine is developed and all people who are given it do not become HIV positive, then we know that the vaccine works ..... If we consider the scientific goal the development of a vaccine for the virus that leads to AIDS, it becomes clear that a successful solution to that problem could not be socially constructed independent of the external world, that is, independent of the nature of the virus. Second, social constructivists' accounts of science can be accepted as descriptively accurate without being accepted as prescriptions for optimal science. Suppose an enterprising reporter uncovers evidence of widespread graft and corruption among local politicians. Do we then accept graft and corruption as part of the formal definition of local politics, or do we view these activities as inconsistent with the ideal of politics and attempt to reduce them? Likewise, if scientists are shown to make decisions based on an attempt to curry favor, advance their careers, and be associated with what is "hot," often in disregard of matters of fact, should we then make these behaviors criterial for science, perhaps replacing courses in research methodology for graduate students with courses on how to be obsequious to the big names in one's field? Third, though the rules of knowing that define positivists' science are clearly socially constructed (and in that sense are no different from the rites of a religious community or the principles of astrology), systems of belief are not without differential consequences. Hopi Indians

Page 10 performing a rain dance, communication facilitators supporting an impaired child's hand, and scientists with a p < .05 effect all believe they are effecting change and all possess an interpretive framework in which their behavior has meaning. We may not be able to determine which of these and other belief systems is true and which is false, and indeed, such questions may be meaningless. We can, however, conclude that the system of belief and practice that Biklen and Duchan label as positivists' science, much as it frequently diverges from its idealization, is differentially likely to produce technological progress. This includes the domain of communicative impairments. We can also conclude that people who call what they are doing science but who do not comport themselves in a manner that conforms to that system of belief and practice should expect to be treated like any infidel in the temple. Thus when Biklen and Duchan (1994, p. 34) say that the controversy is not "about whether the method is successful" in the face of a substantial body of evidence that it is not (Green & Shane, 1994), and simultaneously describe what they are doing as science, they are at best misleading the consumers of facilitated communication, who we venture to guess are not spending the huge amount of time and effort they invest in facilitated communication based on their commitment to social constructivism, and who would certainly be surprised to learn that the world has no objective truths.

Page 11 References Adams, M.J. (1990). Beginning to read. Cambridge, MA: The MIT Press. Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review, 60, 291-313. Biklen, D. (1993). Communication unbound. New York: Teacher's College Press. Biklen, D. & Duchan, J.F. (1994). "I am intelligent": The social construction of mental retardation. The Journal of the Association for Persons with Severe Handicaps. Brainerd, C.J. (1978). The stage question in cognitive-developmental theory. Behavioral and Brain Science, 2, 173-213. Cole, S. (1992). Making science: Between nature and society. Cambridge, MA: Harvard University Press. Cole, S., Cole, J., & Simon, G. (1981). Chance and consensus in peer review. Science, 214, 881-886. Crossley, R. (1992). Getting the words out: Case studies in facilitated communication training. Topics in Language Disorders, 12, 29-45. Green, G. & Shane, H.C. (1994). Science, reason, and facilitated communication. of the Association for Persons with Severe Handicaps. Kuhn, D. (1962). The structure of scientific revolutions. Chicago: University of Chicago Press. Lakatos, I. (1970). Falsification and the methodology of scientific research programmes. In I. Lakatos & A. Musgrave (Eds.) Criticism and the growth of knowledge (pp. 91-196). Cambridge, England: Cambridge University Press. Lawson, A.E., McElrath, C.B., Burton, M.S., James, B.D., Doyle, R.P., Woodward, S.L., Kellerman, L., & Snyder, J.D. (1991). Hypothetico-deductive reasoning skill and concept acquisition: Testing a constructivist hypothesis. Journal of Research in Science Teaching, 28, The Journal

Page 12 953-970. Peters, D.P. & Ceci, S.J. (1982). Peer-review practices of psychological journals: The fate of published articles, submitted again. Behavioral and Brain Sciences, 5, 3-11. Piaget, J. (1976). The grasp of consciousness. Cambridge, MA: Harvard University Press. Sonnenschein, S., and Whitehurst, G.J. (1984). Developing referential communication: A hierarchy of skills. Child Development, 55, 36-45. Whitehurst, G.J. (1984). Interrater agreement for journal manuscript reviews. American Psychologist, 39, 22-28. Whitehurst, G.J., Fischel, J.E., Lonigan, C.J., Valdez-Menchaca, M.C., Arnold, D.S., & Smith, M. (1991). Treatment of expressive language delay: If, when and how. Topics in Language Disorders, 11, 55-68. Whitehurst, G.J., Arnold, D.H., Epstein, J.N., Angell, A.L., Smith, M., & Fischel, J.E. (1994). A picture book reading intervention in daycare and home for children from low-income families. Developmental Psychology, 30, Whitehurst, G.J., & Fischel, J.E. (1994). Early developmental language delay: What, if anything, should the clinician do about it? Journal of Child Psychology and Psychiatry, 35, 613-648.