AAC, FCT and Related Approaches

It is important to understand the difference between Facilitated Communication Training (FCT) and the larger approach of Augmentative and Alternative Communication (AAC). Methods in AAC draw on independent access and seek to discover what part of the body can be used most reliably. For some it means use of the hands. For others it requires movement of the head to a device that scans targets for selection.

For still others it means use of the eyes. For Christy Brown it meant his left foot (My Left Foot by Christy Brown). In AAC, independent access is matched with an appropriate symbol set and often begins with low-tech strategies and works toward highly dynamic systems. The end goal is the highest level of communication possible for that communicator.

Many AAC users get stuck in low-tech systems and overly simplified language because their access strategy is unreliable or inconsistent. They do not have a part of their body that works well enough for them to develop expression to their fullest potential. Their inability to access a device is often interpreted as a lack of intelligence. With FCT, intelligence is left as an open question. Initial assessment focuses on motor planning and supporting a person to be more effective in how they access targets for communication. With support, communicators often reveal a level of intelligence otherwise not seen, a unique and authentic personality. It is from this point that independent access is explored. Some communicators, even initially, have a set of skills to combine independent access (AAC) with supported access (FCT).

There are approaches to communication that are compatible with the use of FCT. Floortime is one method that focuses on building the person's ability to regulate their emotions and engage others through those emotions. The method is the hallmark of Drs. Stanley Greenspan and Serena Wieder. As a person improves in their ability to process sensory information and regulate emotionally, they also improve in their ability to show intentionality, engage in reciprocal interactions and indicate their wants and needs. What needs to also be considered is a person's ability to motor plan. For some individuals, it is the motor system that is interfering with their ability to participate in communication with others. By using the Floortime method together with FCT, you give a person the greatest opportunity to eliminate the obstacles which may be keeping them from the highest level of communication.

There are other approaches, but the following principles are key to combining strategies to meet the specific needs of any individual:

  1. Honor a person's attempts to communicate; work to determine instances when their communication is not authentic.
  2. Establish activities that are interesting and age appropriate.
  3. Set the communication as an invitation, not an expectation.
  4. Develop a partnership that enables their perspective.
  5. Build on the person's strengths.

FCT, when implemented correctly, follows these principles and works well with other approaches that embrace the perspective of the communicator.