Why I Support ASHA in Warning Against Spelling to Communicate (S2C)/RPM
ASHA’s Concerns
ASHA (American Speech-Language-Hearing Association) has expressed serious concerns about the Spelling to Communicate (S2C), also known as Rapid Prompting Method (RPM). Here are the main concerns outlined by ASHA:
Uncertainty of Authorship: ASHA highlights that it is unclear whether the communication expressed through RPM is genuinely from the individual or manipulated by the aide holding the letter board. This uncertainty, known as facilitator bias, arises because the aide may unintentionally influence the selection of letters, thus compromising the authenticity of the communication.
Dependence on Facilitators: RPM creates a dependency on another person for communication, which goes against the primary goal of speech-language interventions—fostering independent communication. This dependence prevents individuals from expressing their own thoughts and words independently.
Lack of Evidence for Effectiveness: ASHA notes that there is no scientific evidence proving RPM's effectiveness in fostering independent communication. Proponents of RPM have been resistant to research that tests the method under controlled conditions, arguing that such research could be demeaning or stressful for participants.
Potential for Harm: The use of RPM can potentially cause harm by diverting individuals from more effective, research-backed communication methods. Families might invest time and resources in RPM without any proven benefits, possibly at the expense of other interventions that have a solid evidence base.
Similarity to Discredited Techniques: RPM is similar to Facilitated Communication (FC), a method that has been discredited and found to be harmful. Like FC, RPM involves a high degree of facilitator involvement, which has led to instances of false allegations of abuse and other serious consequences when using FC.
ASHA strongly advises against the use of RPM/S2C due to these concerns and recommends utilizing other well-established and effective communication interventions that are backed by scientific research and promote independent communication.
You can find their full article on this HERE.
Communication Methods and the Importance of Expression
Augmentative and Alternative Communication (AAC) systems are not inherently limited in their ability to convey expression and tone. Many AAC approaches are intentionally designed to support pragmatic meaning through features such as symbol-based language, message pacing, prosody controls in speech-generating devices, affective markers, and independently constructed utterances. When used as intended, AAC allows the communicator to express emphasis, emotion, questioning, urgency, and intent in ways that preserve agency and meaning.
In contrast, speller-based, facilitated communication methods (such as letter boards or facilitated spelling-to-communicate systems) do not provide a mechanism for conveying expression or tone. These methods reduce communication to linear letter selection without linguistic tools for real-time expressive signaling. Any interpretation of tone or intent must be supplied by the listener rather than conveyed by the communicator within the communication system itself.
This distinction is not superficial. Expression and tone are central to meaning. They determine whether a message is a question or a statement, whether it conveys uncertainty, emphasis, distress, or neutrality. When a communication method removes the ability to encode tone independently, it fundamentally alters how meaning is transmitted and understood.
Because speller-based facilitated methods lack expressive capacity, they raise serious ethical considerations. By stripping away tone and expression, these systems constrain communicative autonomy and increase the risk of misinterpretation. The communicator’s intent becomes vulnerable to projection or inference by others, rather than being clearly and independently expressed.
For these reasons, speller-based facilitated communication methods should not be conflated with AAC as a whole. AAC systems can support expression and tone. Speller-based facilitated methods cannot. Any communication approach that limits expressive capacity must be evaluated carefully, particularly when presented as a primary or exclusive means of communication.
Important things to know
Language development progresses through three key stages: comprehension (ages 0–5), where children learn to understand and assign meaning to language; decoding (ages 5–7), where they interpret symbols like letters into sounds and words; and encoding (ages 7–9), where they organize thoughts into written symbols. For spelling-to-communicate (S2C) to be immediately effective, a child must have already mastered comprehension and decoding and begun developing encoding skills. This requires prior learning of the community’s language system, in which specific sounds and meanings are assigned to symbols. While these programs emphasize presuming competence, presuming competence means believing in a child’s potential, but it’s different from expecting them to independently self-teach the complex skills of decoding and encoding a language without explicit instruction. This is not an impossible task, but it is an extremely rare event. Creating a communication method that hinges on such an occurrence places undue pressure on the child and significantly undermines the overall reliability and success of the method as a practical form of communication. Such expectations are unrealistic for any child, as the symbols and their meanings are based on societal conventions that vary across languages (e.g., English, Spanish, French). Augmentative and Alternative Communication (AAC) is the preferred, research-backed method of communication for nonverbal children because it meets them where they are developmentally, whether through comprehension-stage supports like photos or more advanced tools like keyboards and typing.
The time spent expecting a child to independently develop the skills of decoding and encoding can result in a period of language deprivation, during which the child is left without effective communication. Research with deaf children who were denied access to American Sign Language (ASL) has demonstrated that language deprivation during critical developmental windows can lead to lifelong cognitive impairments. Similarly, relying on a method like S2C without providing an accessible alternative risks delaying meaningful communication and exposing the child to unnecessary developmental harm. Further research is needed to examine the effects of language deprivation in nonverbal children and its long-term impact on cognitive and social development.
When choosing a communication method for your child, remember that you are selecting what will essentially be their first language. Understanding this language is critical, as comprehension (receptive language) typically precedes expression (expressive language). If you choose a method like Spelling to Communicate, it is essential to ensure that it teaches spelling and the comprehension of what is spelled in tandem, which does not currently appear to be part of their program. Unlike Spelling to Communicate, AAC or PECS are supported by research showing that comprehension begins visually, with images preceding word recognition, which underpins their effectiveness.
Caution Against Using S2C/RPM as a Last Resort
Spelling to Communicate (S2C)/RPM requires children to first develop motor skills to point to letters, then learn how to spell, and only afterward use spelling to communicate. This lengthy process delays access to effective communication compared to picture-based systems like AAC or PECS, where children can immediately recognize and use images to convey thoughts without needing to learn how to spell first. Relying on S2C as a last-resort method risks significant delays during critical language development periods, especially if started once this window has already passed, potentially leading to cognitive and social setbacks (National Scientific Council on the Developing Child, 2007)(Hall, 2017). Visual systems like AAC and PECS bypass these barriers, offering faster and more accessible communication options.
AAC Evaluations and Dynamic Assessment
The best option to decrease any missed opportunity cost in development would be an AAC Evaluation. ASHA defines dynamic assessment as a flexible and interactive method that identifies both a child’s current language skills and their learning potential. In AAC evaluations, this approach involves active client participation, adjusting the assessment based on the child's needs, and adapting throughout the process. This allows for a responsive evaluation that matches the child’s communication preferences, ensuring a more personalized and accurate understanding of their abilities and potential for growth with AAC tools.
Kansas Speech-Language-Hearing Association has a great overview of this process, you can find the slideshow HERE.
To find options near you, keyword search your browser of choice for “AAC Evaluations Near Me” or “AAC Evaluations in (Your Home State/County)”
AAC Assessment Tools can be found HERE.
Spelling Boards on AAC Devices with Predictive Text
For individuals who benefit from spelling-based communication, many AAC devices offer spelling boards equipped with predictive text features. These tools allow users to begin typing letters, with the device predicting and suggesting possible words based on partial inputs, streamlining the communication process. This feature reduces the physical and cognitive demands of spelling out each word, especially for individuals with motor challenges or slower typing speeds. It provides a more accessible alternative to traditional letterboards, offering the same functionality while significantly improving speed and accuracy. Predictive text in AAC devices enhances communication by providing immediate suggestions, ensuring that users can express themselves more efficiently without the need for full word spelling. These systems support independence and reduce frustration by minimizing the effort required to communicate, making them a valuable option for individuals who require spelling to express their thoughts but also benefit from technological assistance.
Enhancing Hand-Eye Coordination: Physical Therapy Aspect of S2C
Spelling to Communicate (S2C) has shown potential in improving hand-eye coordination through the precise motor tasks required to operate letterboards or keyboards. These activities involve detailed coordination between visual inputs and fine motor actions, which can strengthen essential motor skills. While these benefits are notable, they pertain more to physical therapy aimed at enhancing motor abilities than to effective communication strategies.
Communication vs. Physical Therapy: Maintaining Clarity
It's crucial to differentiate the physical therapy benefits of S2C from its efficacy as a communication method. While improved hand-eye coordination is beneficial in a therapeutic context, using such physically demanding tasks on a demographic who struggles with motor movement may result in lack of ability to achieve the speed required for fluent communication. Effective communication should be accessible and straightforward, allowing individuals to convey their thoughts and needs as effortlessly as possible, especially for the request of basic needs. In this light, it's important to differentiate S2C's physical therapy benefits from the potential harm in its role in communication, ensuring that the method does not become a barrier to expressing basic needs, akin to requiring someone to run to communicate.
Lack of Empirical Evidence vs Lack of Support Based on Developmental Science
Proponents of Spelling to Communicate (S2C)/RPM argue that criticisms for not being "evidence-based" misunderstand the concept in educational contexts, suggesting that formal, empirical validation is impractical due to individual student differences. They define evidence-based practices more broadly, including clinical expertise and client preferences. However, extensive developmental research suggests that S2C's focus on motor skills could be detrimental, particularly for autistic learners who might struggle with the motor demands required for this communication method. It also overlooks the critical integration of literacy skills, potentially hindering overall learning and cognitive development for nonspeaking children. Therefore, this approach may delay engagement with more effective communication aids like AAC devices that don't rely on fine motor control and also teach comprehension of the language alongside execution of the method utilized.
Comprehensive Analysis of S2C and Child Developmental Science w/ Emphasis on Nonspeaking Children
What is S2C?
Spelling to Communicate (S2C) is designed for nonspeaking individuals, particularly those with autism and apraxia, to develop motor skills necessary for spelling words and expressing thoughts. This method involves teaching intentional motor skills to accurately point to letters on a letterboard or keyboard, facilitated by trained practitioners through a structured progression.
Fundamental Challenges of S2C in Light of Child Development
Critical Periods in Language Development: The theory of critical periods in language development highlights a window during early childhood where the brain is exceptionally receptive to language learning. Research indicates this period peaks by age 6 (National Scientific Council on the Developing Child, 2007). S2C's reliance on developing complex motor skills before effective communication can occur means that its introduction and mastery could miss these critical developmental windows, potentially leading to suboptimal language and cognitive outcomes.
Language Development Prior to Spelling: To become fluent in Spelling to Communicate (S2C), a child would need to first develop foundational motor skills, such as learning to point accurately at letters. They would also need to learn the ABCs, word meaning/comprehension, and how to spell. Since spelling and typing require knowledge on how to spell, read, and fine motor control, fluency in S2C might not occur until late elementary years (ages 8-10) or later, if at all, due to the known difficulties in hand eye coordination, reaching, and fine motor skills in autistic children (Gowen et al., 2023). This timeline conflicts with the critical period for language development, which peaks by age 6 (National Scientific Council on the Developing Child, 2007), meaning many children might not gain access to full communication before this sensitive window closes, and that is if there is no delay in starting S2C as a method of communication.
Motor Skills Development Versus Language Acquisition: Altered motor coordination is a common feature in autistic individuals, present from infancy through adulthood, and affecting a wide range of movements, including fine motor skills (like finger movements), eye-hand coordination (such as reaching and grasping), and gross motor skills (such as balance and gait) (Gowen et al., 2023). Successful reaching relies on the integration of the entire body, requiring precise control of the hands, eyes, and head while maintaining stable postural support (Franchak & Yu, 2015). Meaning autistics may have significant challenges with motor skills that S2C heavily relies on, and these skills would need to be addressed first prior to language acquisition. This reliance can delay the engagement with direct language experiences that are crucial for cognitive development. The method’s focus on motor abilities contrasts with AAC approaches that provide immediate language interaction opportunities, which are vital for fostering communication and language skills (Franchak & Yu, 2015).
Educational Gaps in S2C Methodology
Literacy Development: Literacy development follows a structured process. In the pre-alphabetic phase (typically ages 3-4), children rely on visual cues or context rather than letter-sound knowledge to “read” words, making tools like PECS useful for nonspeaking children as it aligns with this stage. To progress to the partial alphabetic phase, children must learn letter shapes, names, and sounds, and develop the ability to identify phonemes in spoken words. In the full alphabetic phase, they need to understand letter-sound relationships (grapheme-phoneme correspondence) and learn to decode and blend sounds to form words, which is taught through phonics instruction. With systematic phonics and practice in kindergarten and first grade, children begin to consolidate spelling patterns, reaching the consolidated alphabetic phase by second grade. At this point, they can recognize multi-letter units like syllables, prefixes, and suffixes, enabling more fluent reading and spelling (Ehri, 2023).
Lack of Phonics and Comprehensive Literacy Training: The method does not appear to offer instruction in key areas of phonics, reading comprehension, or literacy development, which are essential components for understanding the words being spelled. While S2C focuses on motor skills for communication, it lacks the critical elements of language acquisition that help individuals not just spell, but understand and use language effectively. This is a notable gap in a communication method, as phonics instruction is crucial for learning how to read and decode words, and reading comprehension is necessary to understand the meaning behind those words. Without the inclusion of systematic literacy instruction, individuals using S2C may struggle with fully grasping the language they are using, leading to challenges in language development. This raises concerns about the effectiveness of S2C as a standalone communication tool, especially for individuals needing a more holistic approach to language learning.
Potential Long-term Consequences of S2C/RPM, Even as a “Last Resort”
Potential Cognitive and Language Deficits: The impact of the additional delays required to teach how to spell/read before S2C/RPM can be utilized with intent, in a group who are already delayed in acquiring a first language/access to language requires more research. Existing research indicates that children who are deprived of access to language, within the critical time period of language acquisition, may face lifelong challenges in language and cognitive development (Hall, 2017). These milestones have critical time periods that must be met. More research is needed on the impact of selecting a first language that requires understanding how to spell before implementation vs pecs like images.
Conclusion
While S2C/RPM aims to enable communication for nonspeaking individuals through the development of motor skills necessary for spelling, it lacks integration with critical language development principles and literacy, which are essential for comprehensive language acquisition required in the spelling portion of spell to communicate. The focus on motor skills not only delays direct language learning but also overlooks the immediacy and accessibility of AAC tools that could offer more effective communication solutions from the start. This is especially relevant due to the difficulty in motor skills in this demographic.
Resources:
American Speech-Language-Hearing Association. (n.d.). ASHA warns against Rapid Prompting Method or Spelling to Communicate. Retrieved from https://www.asha.org/slp/asha-warns-against-rapid-prompting-method-or-spelling-to-communicate/
National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5. http://www.developingchild.net
Franchak JM, Yu C. Visual-motor coordination in natural reaching of young children and adults. Cogsci. 2015 Jul;2015:728-733. PMID: 29226279; PMCID: PMC5722454.
Gowen E, Earley L, Waheed A, Poliakoff E. From "one big clumsy mess" to "a fundamental part of my character." Autistic adults' experiences of motor coordination. PLoS One. 2023 Jun 2;18(6):e0286753. doi: 10.1371/journal.pone.0286753. PMID: 37267374; PMCID: PMC10237488.
Hall WC. What You Don't Know Can Hurt You: The Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children. Matern Child Health J. 2017 May;21(5):961-965. doi: 10.1007/s10995-017-2287-y. PMID: 28185206; PMCID: PMC5392137.
Ehri, L. C. (2023). The science of learning to read: Bridging research and practice. American Federation of Teachers. https://www.aft.org/ae/fall2023/ehri