Rapid Prompting Method: History repeating itself
A client told me of a recent visit to a pediatrician's office. The pediatrician explained to my client's child what he needed from the child in order to perform an exam. When the child's mother told the physician that her child didn't understand what he said, he responded by saying, "Children on the spectrum really understand everything that is said to them". The belief that 'children on the spectrum understand everything' is a meme that has infected the culture at large.
What does it mean to hold such beliefs? "What do we mean by understanding" Why is this question important? These questions are important because misuse of the term distorts the phenomenon of 'understanding' (Hacker, 2013) and renders it meaningless. Its misuse leads to well intention-ed but misguided intervention and uncertainty.
What we mean by understanding
To 'understand' something is akin to an ability. Thus, to say that I understand calculus, means that I will be able to solve differential equations. My understanding is manifest in what I do. If I pass my calculus exam, my teacher will be able to say that I "understand" calculus. Similarly, if it is to be said that a child understands what their teacher tells them to do, e.g., 'get the ball on the chair', the child will be able to do it when asked. One's ability to do calculus or retrieve a ball remains whether or not they perform the tasks at a given moment. Thus, understanding is not behavior. Even when sleeping, understanding remains.
'Understanding' and language
In language, to say that someone understands a word is manifest in their ability to use it in certain ways for a certain purpose just as knowing how to play chess is knowing how to move the pieces within the rules of chess in pursuit of the goal of winning; in both cases, a technique is mastered." (L. Wittgenstein, unpublished, cited in Wittgenstein's Nachlass). 'Understanding' something expressed in language consists of being able to explain what the uttered sentence means, to use it properly or at least to be able to respond to it appropriately. To ascribe the term "understanding" absent anything manifest violates the conventions for the use of the term... and strips the term of all meaning. Doing so is just confused and confuses.
What happens when the term "understands" is misapplied?: The Rapid Prompting Method
It's this kind of confusion concerning 'understanding' that drives the Rapid Prompting Method (RPM) phenomenon (and its cousin, Spelling to Communicate - S2C and other members of that family) and which drove the Facilitated Communication (FC) disaster. Within these systems, it is believed that persons with autism understand everything, but simply can't express themselves and they need the assistance of others in order to unleash otherwise hidden abilities residing somewhere in the brain. While Facilitated Communication was fully debunked, its iteration, RPM and cousins are wildly popular.
RPM requires that an adult hold a letter board while a child/adult "types" fully formed sentences-prose. The reason given that adults need to hold the board is that persons with autism don't have the motor control to type 'independently'. Yet, in promotional videos for these approaches, we see the same 'motorically challenged' persons painting elaborately detailed pictures and skiing moguls. And shouldn't we ask, why the need to hold the board? If someone knows how to spell, wouldn't the ability be manifest without someone holding the board or keyboard? You'd think.
Additionally, while the emphasis in these dramatic displays is on expressive language, a simple way to assess language abilities is to assess receptive language. Are the same persons who are able to 'type' able to follow simple directions such as to retrieve a ball, touch their nose, place a green big square under a little yellow plate, clap three times? Why isn't anyone asking this question? My experience when meeting persons using this system is that they were unable to follow these kinds of simple directions. The reason given is often, "They don't want to" or they "don't feel like it today" or some related explanation. There is nowhere to go when such reasons are given and thus, any reasonable effort to evaluate abilities are dead in the water.
The same question that brought down FC needs to be raised concerning RPM, i.e., "Is inadvertent manipulation of the board occurring in the same way it was revealed in many studies that inadvertent manipulation of children's arms occurred during FC? (See Hemsley, B., Bryant, L., Schlosser, R. W., Shane, H. C., Lang, R., Paul, D., Banajee, M., & Ireland, M., 2018 for a current review.) Another way to ask this question is, "Whose understanding is manifest, the person holding the board, or the child's?" Although this question concerning RPM is currently unanswered , the practice persists, largely because it is believed that 'understanding' exists sans expression... that understanding is just 'in there waiting to get out'. Certainly, a child's ability to respond appropriately to language as evidenced by being able following directions (e.g., go to my room and get me Mommy's pillow) would point to language abilities/understanding. Yet somehow, asking children to demonstrate such abilities is overlooked. Why is that?
Respect for our students demands certainty
Our job as (language) instructors is to help children so that we can say, without equivocation, they "understand"... to see to it that children are able to respond to, and that they are able to do things with words or gesture (symbols) with a purpose, on their own. Let's at the very least, not misuse the term 'understanding'. To hold the belief that children with autism understand everything that is said to them helps no one. Concerning RPM, the fact that we can't know who actually 'understands' is troubling. Such a question would not be difficult to answer. Research methods similar to those used in the FC studies would work equally well for investigating RPM.
Vigilance should be key in our teaching practice, such that practical and critical assessment of abilities is of utmost importance. If motor abilities are a factor in limiting a person's abilities to communicate, there are technologies available which would unequivocally allow for the ascription of the term 'understands'. For example, consider the technologies employed for persons with 'locked-in' syndrome. No one questions the understanding / language abilities of persons using these ingenious systems. If uncertainty exists, who benefits? No one likes when others put words in their mouths. What could be more disrespectful? Alternatively, what could be more respectful of children we work with than to be certain that the words uttered are their own. Finally, the danger of putting words in the mouths of others has been sadly and catastrophically demonstrated with FC. Let's not risk going there, again.
