ASHA Warns Against Rapid Prompting Method or Spelling to Communicate

Very rarely does the ASHA take a formal position against a technique purported to help children communicate. But that is the case with the Rapid Prompting Method (RPM), also known as Spelling to Communicate and a range of other names.

In 2018—following an exhaustive review by ASHA—RPM was found to lack supporting scientific evidence and to be potentially harmful in its similarities to the long-discredited technique known as Facilitated Communication, or FC, also known as Supported Typing. Despite the lack of credible evidence, some press reports have suggested that RPM has beneficial effects without mentioning its potential for serious harm. ASHA members continue to report concern about the use of RPM in schools and other settings. Several other consumer and professional organizations have adopted positions discouraging the use of RPM.

What is RPM?

RPM is described as a teaching method that leads to communication for autistic children. Using RPM, an aide holds a letter board (typically in the air) and provides physical and/or verbal prompts (e.g., pointing, moving the letter board, giving verbal reprimands) designed presumably to get a child to spell out words or messages on the letter board.

RPM requires an aide to physically hold the child’s alphabet board at all times. Proponents claim that this technique helps autistic children and others who have limited verbal abilities to “spell to communicate.” RPM proponents also claim that the technique can uncover previously unknown reading and writing abilities. Although this claim may sound innocuous, it’s far from it.

RPM effectively strips people of their human right to independent communication because the technique relies on an aide for prompting. This reality raises a host of questions, concerns, and possible dangers. With RPM, children miss out on critical services tailored to their needs, jeopardizing their development, education, and autonomy.

Taking risks with a child’s communication development is unnecessary. There are a variety of well-established and effective interventions, backed by extensive research, designed for people with complex communication needs. Speech-language pathologists (SLPs) help families find the best evidence-based communication interventions that work for the specific needs of the child.

Why does ASHA advise against the use of RPM?

Following a year-long comprehensive systematic literature review, expert panel discussions, and public comment period, ASHA adopted a policy position that advises against the use of RPM. ASHA has several concerns about the technique:

1. There is uncertainty regarding who does the spelling.

With RPM, you can’t tell whether the words being spelled out belong to the autistic child—or to their aide. The aide holding the alphabet board may move the board unintentionally in the direction of the letter that they think the child should select next. This is called facilitator bias, a documented phenomenon in which a helper unintentionally influences the message produced. Aides might well have good intentions, but in using RPM, they may unknowingly insert their own assumptions and thoughts into the message. A simple way to reduce facilitator bias is for the aide to place the alphabet board on a table or mount instead of holding it in the air.

2. RPM creates dependence on another person, thus preventing independent communication.

The primary goal of speech-language intervention is independent communication, which is a basic human right. Independence is critical: It ensures that the words, thoughts, and feelings an individual expresses are indeed their own and not the words of another person.

3. RPM lacks evidence of effectiveness.

There is no research showing that RPM is effective in producing independent communication. Indeed, there is active resistance by RPM proponents to conducting research on the technique. They claim that research may put children in stressful testing situations—and that the process of conducting research is insulting or demeaning. From a scientific standpoint, this avoidance of appropriate testing of the technique, and this resistant attitude toward examining RPM, raises serious red flags about the technique.

4. RPM holds the potential for harm.

Children and their families can incur serious harm from the use of RPM. They risk wasting months to years on an unproven method when effective and appropriate interventions already exist. Untested techniques, like RPM, often prey upon vulnerable families. Families also risk losing money and time—which may already be scarce—that cannot be retrieved. Parents are often asked to travel long distances to attend expensive workshops to learn the technique.

5. RPM is similar to a discredited and dangerous technique called Facilitated Communication (FC).

FC is a pseudoscientific technique that has been widely discredited in a large body of published, peer-reviewed, scientific research. FC has resulted in serious harm to people with disabilities and their families, including false allegations obtained through FC of sexual abuse and maltreatment.

When is the use of a letter board appropriate?

Children and adults with limited oral speech may use a keyboard to type out messages. When used independently, letter, word, and picture boards are valid examples of augmentative and alternative communication (AAC). AAC encompasses a variety of low-tech communication boards and high-tech speech-generating devices that help a person communicate. There are several ways to use these systems, including the use of eye gaze if the person cannot use their hands to access the system. SLPs are the trained professionals who can help people with severe speech and language difficulties find the best AAC option for them.

Learn more about AAC and how SLPs can help.

Comparing AAC With RPM and FC: What Sets AAC Apart

Features of AAC, RPM, and FC ✓ = present X = absent	Augmentative and Alternative Communication (AAC)	Rapid Prompting Method (RPM)	Facilitated Communication (FC)
Core Treatment Components
Starts with presumption that child is capable of learning and communicating.	✓	✓	✓
Can include use of an alphabet board.	✓	✓	✓
Uses prompts and other instructional techniques to teach the child to use an alphabet board/assistive device—and these prompts and teaching procedures are eliminated when the skill is acquired.	✓	X	X
Is supported by published peer-reviewed scientific research that validates claims of efficacy (studies producing verifiable and replicable results).	✓	X	X
Is recognized by clinical professionals and researchers across disciplines as an ethical and legitimate form of communication.	✓	X	X
Supports independent communication and access to the human right of communication.	✓	X	X
Potential Harms
Denies people their human right of independent communication.	X	✓	✓
Always requires an aide for prompting, and prompts are not phased out.	X	✓	✓
Does not align with existing research and long-standing knowledge about communication development and learning.	X	✓	✓
Holds potential for misappropriated messages and false claims of abuse.	X	✓	✓
Replaces effective individualized communication support and educational opportunities by diverting resources (time and money) to an ineffective technique.	X	✓	✓
Gives false hope and promotes unsubstantiated claims of unlocking hidden talents.	X	✓	✓