Proposed ASHA Position Statement: Rapid Prompting Method (RPM)

June 23, 2018

For those interested, the following is my letter in response to the proposed position statement by the ASHA  American Speech-Language-Hearing Ad Hoc Committee on Facilitated Communication (FC) and Rapid Prompting Method (RPM).   The proposed policy can be read here.

 Dear  ASHA Board of Directors:

My name is Chantal Sicile-Kira and I am the author of  five books on autism, an International speaker,  and I am known for my practical advice to parents and educators. Many years ago, I worked for two years at Fairview State Hospital (now called Fairview Developmental Center) and taught  functional and community living skills to the first group of young adults in preparation for de-institutionalized following the passage of the Lanterman Act. I also worked for a short time at Orange County Regional Center as a case manager to families of children with developmental disabilities.

As well, I  have 25 years of experience in non-profit leadership roles related to autism, including two years as Co-Chair, South Counties Autism Regional Taskforce, reporting to the California Legislative Blue Ribbon Commission on Autism, and two years as Member, Taskforce on Transitional Services & Supports reporting to the California Legislative Blue Ribbon Commission on Autism. I am also the parent of Jeremy, a 29 year old who learned academics and  communication skills using RPM (The Rapid Prompting Method), and continues to do so as a fully-included productive individual with a number of trained communication partners.

I respectfully encourage ASHA to withdraw the proposed position statement in regards to RPM.   I am very concerned that The Ad Hoc Committee has refused to consider input or evidence from  users and ASHA members with experience in these methodologies. Such important policy decisions should involve a careful unbiased examination of different viewpoints.  I believe that more research is indeed needed. I also believe that a  professional or parent trained in the methodology is capable of making a decision on whether or not a method is worth trying with a certain  individual, and then verifying success or not on a case by case situation.

I share my experience below with my son’s permission. We hope this will enlighten you as to how for certain individuals, RPM can be an effective method of academic and communication skills.

While doing research on educational methodologies and medical interventions  to write my books, I read about the evidence- based practices that were considered effective. I also learned  about educational methodologies and medical interventions  that did not yet have research evidence, because no research had yet been done. However, some of these interventions were effective with some individuals.  As a parent and autism professional, I believe that there are practices that can be tried and validated on an individual basis. RPM is one of those.

I first heard of RPM when doing the research to write one of my books, Autism Spectrum Disorders (2004 Penguin, Autism Society of America, Book of the Year 2004; Revised-edition 2014 Penguin).  I decided to try it with my son, as it made sense for him and his challenges. Jeremy received direct instruction from Soma Mukhopadhyay (at the time living in LA) twice a month, and I practiced with him every day for half an hour. We did this for approximately two years.

When Jeremy was born he was hypotonic. He needed physical therapy to learn to sit straight, and to use his arms and legs. Every time he learned a new skill (ie eating with a spoon or fork) he needed hand over hand prompting. He had speech therapy as a toddler,  but it was not effective (again, muscle tone challenges).  When he was 5-6 years old he had a supervised home-based ABA Lovaas program. I did ten of the 40 hours of ABA therapy a week  myself, which meant I learned about how Jeremy learned – or didn’t learn.

Jeremy learned to identify and correctly label verbally over 100 pictures. However, if you put the pictures in front of him, he could not give you the correct picture requested at a 80-100% success rate. Since he could verbally identify the objects introduced to him one by one, we knew he had receptive language.  When he was 7 PECS was tried both at home and school. He communicated using a sentence for first time using the “I want… “ sentence strip plus icons in a binder (iPads did not exist till he was out of high school). He had a difficult time choosing the icon out of the binder books and putting it on the strip (vision processing and motor challenges). He never progressed past the “I want”  sentence. Professionals over the years described Jeremy as having challenges similar to a person with CP. He continues to have sensori-motor challenges and visual processing challenges, although these have improved over the years with exercise and therapy.

Therefore, when I heard about RPM, it sounded like something that was worth trying with Jeremy. Success was slow, but obvious. It was not a “magic pill” and it did not cure his autism – but that was not my goal. My goal was effective communication  with a variety of communication partners for use in daily life and with living skills, and to allow him to make choices and decisions,  to blossom as an individual, and have a productive life as an adult.

When Jeremy was in high school he began using RPM at school with a variety of communication partners  trained and supervised by a Speech and Language Pathologist trained in FC who understood the strategy of RPM.

Jeremy graduated from high school at age 21 with a full academic diploma. He auditioned for, and was chosen to give a commencement speech at graduation. During his high school years he was able to participate in general education classes, as well as a class in journalism. In his English classes  and  his journalism class, Jeremy learned effective writing skills and his love of writing to share his thoughts and opinions. He was asked to write a monthly column for the school newspaper.

More importantly,  Jeremy was able to communicate appropriately and effectively when he was sick or in pain. He was able to make choices and life impacting -decisions  and  tell us what he was feeling.   Thanks to learning communication skills via RPM, Jeremy  now has a full  and productive life, fully – included in his community. For more details in regards to his accomplishments since high school, please read his  attached resume. (For those reading this blog post, some of Jeremy’s accomplishments are listed on his website).

Without having a way to communicate, Jeremy would never have been able to tell us about his gift of synesthesia, and we would not have been able to encourage him to follow this path as a career. As you know, the unemployment rate for autistic adults is very high. We are grateful that we found out he has a gift that can help him be productive.

If ASHA’s mission is  “Making effective communication, a human right, accessible and achievable for all,” then why  are some in  ASHA suggesting withdrawing a system of communication that is obviously effective for some people? Clearly more research is needed. But if finalized, the proposed statements would severely restrict ASHA members’ discretion and ability to exercise professional judgment. It would also and would make ASHA’s assertions about wanting to respect “client preferences and values” untrue.

I hope that ASHA does the right thing and upholds the human rights of all, including those who communicate in the manner that my son does.

Sincerely and respectfully,

Chantal Sicile-Kira

 

Life with Autism: Mighty is the Fear

September 23, 2012

Two caregivers were arrested this past week in Valley Center (near San Diego, CA) for allegedly abusing a severely autistic non-verbal young man in his home. They had been in the family’s employ for over two years and were caught on videotape over a three week period.

This is a parent’s worst nightmare come true; and if it’s a nightmare for the parent imagine what it is like for the victim.

According to reports in the media, the mother, Kim Oakley,  saw changes in her son, Jamey, indicating he appeared to be unhappy on the days following the men’s shifts. Kim also realized Jamey was trying to communicate something to her. When she questioned the caregivers, “They blamed everything on his severe autism,” according to newspaper reports. Kim set up a surveillance camera after noticing that the wires to a baby monitor had been cut. Videos shot over a three week period led to the arrests.

My heart goes out to Kim and Jamey and the rest of the family. Unfortunately their story is not unique and it highlights the difficulties of all families requiring caregivers and support staff for their severely autistic loved one.

How often do we hear about a non-verbal person that “his behavior is due to his autism”? Bull! All behavior is communication and Kim, like most moms and dads, know this. Watch “Autistic Cases ‘Autism Experts’ Run From”    that Kim Oakley posted on YouTube. Jamey’s behaviors  in this video were particularly bad because he had a Urinary Tract infection and once it was diagnosed and treated, he was better. But is took five days to get it taken care of.

Recently my autistic son Jeremy was in so much pain that he became hyper and aggressive and kept trying to take showers as if that would help. Nothing could calm him down. We had never seen anything like it before. He was uncontrollable. We were lucky he could type and tell us he was in pain. But it also took five days to figure out why he was in pain, and a week to be able to do anything about it. Turns out is was due to a change in the generic brand of his medication for epilepsy – we were not warned that any changes in the brand could cause such reactions. You can read Jeremy’s comments about his experience here.

To top it off, the lack of understanding and caring from some of the people at the pharmacies we had to deal with was appalling. Seeing your child suffer and not being able to do anything about it is excruciating, and when those supposedly there to help are not treating the situation with the urgency it warrants is unbelievable. As parents, we try to remain calm and act ‘normal’ and polite so we won’t be taken for one of those ‘crazy  parents’.  We are not crazy.  But we have no patience for not being taken seriously and being dependent on people who just don’t get it. Believe us when we tell you our child is in pain and we need help NOW.

When you have a non-verbal child or a child dependent on caretakers, there is always the risk of abuse, and not just at home. The same risk exists in residential facilities, community living options and even in day programs, camps and community activities. To this day, my son Jeremy suffers PTSD due an abuse that occurred outside the home years ago. He still refuses  to participate in any activities that are not inclusive, that are intended for developmentally disabled participants. As he puts it, “They are grouping the victims.”

Although Jeremy received therapy with some help from the California Victim Compensation Program, he continues to have panic attacks which impact his ability to participate in all that he would like to do outside the home. Recently he had flashbacks and he would flail out and hit whomever was standing close, ‘seeing’ his aggressor. This adds another dimension to hiring and training staff.  As well, it leaves  Jeremy feeling terrible about his outbursts. Dealing with PTSD has become  important to him and recently he completed a painting about his PTSD entitled “Mighty is the Fear.”

Even without thinking about abuse, finding people who understand the importance they have to a person’s quality of life  and the willingness to make the commitment is not always easy when someone requires 24 hour supports. Recently, one person who was hired and trained as a support person and communication partner for Jeremy decided to extend their vacation from two weeks to four weeks, meaning the person would not be around to support Jeremy at either his college class or after school doing his homework at the beginning of the school year as  expected.  This was a big blow to Jeremy and to his ability to attend college successfully.

Most of our experiences with support staff, service providers, medical professionals and others have been extremely positive. Usually I focus on writing about  positive  experiences and strategies, but hearing  about Kim, Jamie and their family’s experience with the two caregivers hit a nerve and I couldn’t stay quiet.  I feel terrible for the family.  Stay strong, Kim!

Trying to learn from all our experiences and focusing on the positive relationships we have forged over the years due to Jeremy’s need for supports is how we continue to survive and thrive.  As Jeremy put it in A Full Life with Autism (Macmillan 2012), “I learned there were really bad people who could do things to your body, but I learned that you don’t have to let them in your soul.“

Ain’t that the truth!