F

FACILITATED COMMUNICATION

Facilitated communication is a controversial tech-
nique for assisting individuals with autism and related
language impairments to communicate. It typically
involves an adult facilitator who physically guides the
individual’s hand to select letters or symbols from a
communication device, such as an alphabet board.
When facilitated, many individuals with autism have
supposedly shown unexpectedly advanced language
skills, including the ability to spell and compose high-
ly sophisticated messages. The technique is contro-
versial because the facilitator may intentionally or
unintentionally influence the selection of letters or
symbols. Indeed, considerable experimental evidence
has shown that, more often than not, it is the facilita-
tor, rather than the individual being facilitated, who
is responsible for the content of the resulting mes-
sages. In light of this evidence, numerous profes-
sional groups have issued position statements high-
lighting the lack of empirical support for facilitated
communication and the need to verify that facilitated
communications are free from facilitator influence.

See also: AUTISM

Bibliography
Jacobson, J. W., J. A. Mulick, and A. A. Schwartz. ‘‘A History of Fa-
cilitated Communication: Science, Pseudoscience, and Anti-
science Science Working Group on Facilitated
Communication.’’ American Psychologist 50 (1995):750–765.
Konstantareas, M., and G. Gravelle. ‘‘Facilitated Communication.’’
Autism 2 (1998):389–414.
Jeffrey Sigafoos

FAILURE TO THRIVE

Children who fail to grow properly have always exist-

ed. In earlier times when many children did not sur-

vive the first few years, small or sickly children were

a fact of life. More recently, medicine has increasingly

turned its attention to the unique problems of chil-

dren, among them the problems of growth failure

and most interestingly to the problem of malnutrition

and growth failure in children without obvious organ-

ic illness. The case of so-called nonorganic failure to

thrive, growth failure without apparent medical

cause, is the main focus of this discussion.

The medical concept of ‘‘failure to thrive’’ in in-

fants and young children dates back about a century.

L. Emmett Holt’s 1897 edition of Diseases of Infancy

and Childhood included a discussion of a child who

‘‘ceased to thrive.’’ Chapin correctly recognized in

1908 that growth failure was primarily caused by mal-

nutrition, but that temporarily correcting caloric in-

take and improving growth often proved futile after

the child returned to her (often impoverished) envi-

ronment. By 1933 the term ‘‘failure to thrive’’ formal-

ly entered the medical literature in the tenth edition

of Holt’s text.

Failure to thrive is not a discreet diagnosis or a

single medical condition (such as chicken pox), but

rather a sign of illness or abnormal function (as a rash

or fever may be a sign of chicken pox virus infection).

In infants and young children, the term ‘‘failure to

thrive’’ is most broadly defined as physical growth

that for whatever reason falls short of what is expected

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