As part of 2016’s Autism Acceptance Month, Apple released an uplifting video called Dillan’s Voice, in which a nonverbal teenager delivers a speech at his graduation, his text turning swiftly to spoken word through his iPad. Before he had the iPad, he says in the video’s voiceover, people thought he didn’t have a mind, that he wasn’t in control. We watch him going for a run as the sun rises, doing pull-ups at the gym, walking alone along a school corridor, his hands flapping, humming occasionally, but it’s a life lived mainly through silence. Then, we move to his middle school graduation ceremony as he steps confidently up to the podium, award medals around his neck. “We are the reality of our thinking lives,” he tells the audience, urging them to open their minds. We hear enthusiastic applause, resounding cheers, the video fades to the Apple logo.
“All my life I wanted so badly to connect with people, but they could not understand because I could not communicate. But now you can hear me,” a voiceover reads. “The iPad helps me see not only my words, but to hold onto my thoughts… No more isolation. I can finally speak with the people that love me.”
Dillan’s Voice features something called “assistive technology”: devices and systems that maintain, increase, or improve the functional capabilities of those with differences and disabilities — including voice recognition software, screen readers, adaptive keyboards, and eye tracking devices. Recent years have seen groundbreaking advances in the assistive technology sphere. Individuals are using iPads and third-party apps and devices to make themselves heard, from Sady Paulson directing and editing features using Switch Control on her Mac, to Charlie, aged six, saying “mommy” for the first time using Proloquo2Go on his iPad.
But there was something different about this Apple video: in it, the teen uses Rapid Prompting Method, or RPM, a form of communication that depends on a “facilitator” or “communication partner” standing close by, providing continuous physical and verbal cues. RPM has been labeled pseudoscientific, unethical, and inhumane. Michelle Dawson, an autistic researcher, called it “bad science and bad ethics.” The American Speech-Language-Hearing Association (ASHA) says that “RPM is a technique without any research support.”
Over the next year, Dillan’s Voice generated significant buzz. A single tweet about the video, which does not explicitly discuss RPM, generated over 230 million impressions. It has reached 4.4 million YouTube views. It was featured on the Today Show, highlighted by Mashable, BuzzFeed, The Huffington Post, Forbes, Metro UK, and shared across disability and autism blogs. The there was a follow-up video that also featured RPM, a nomination for a 2017 Webby Award and a series of other Accessibility videos.
This video had reach.
“It is regrettable that this pseudo-scientific method was featured in an Apple promotional video and received worldwide viewing,” says Howard Shane, an associate professor at Harvard Medical School and director of the Autism Language Program and the Center for Communication Enhancement at Boston Children’s Hospital. He adds that it is not supported by research and that its underlying theory is “nonsensical.”
Concern over the RPM system hinges on how it works, and questions remain surrounding whether the method facilitates real first-person communication, or creates dependence on outside cues and interference from a user’s communication partner.
RPM was developed in the early 1990s by Soma Mukhopadhyay, the mother of an autistic child, who, like about one-third of individuals diagnosed with autism, was nonverbal. RPM is based on what’s called a Teach-Ask paradigm, explains the FAQ page of Helping Autism through Learning and Outreach (HALO), the organization that Mukhopadhyay joined in 2005. It works like this: the communication partner, or interlocutor, begins with a few sentences on a subject and then asks a related question:
“A square has 4 sides. What did I say? Does a square have 4 sides, or 3 sides?”
The interlocutor then writes the two possible answers on separate pieces of paper, tapping the choices while reading and spelling them aloud and then “encourages the student to pick up the correct answer.” If they are “auditory learners,” they might not look or read the answers, but instead rely on the tapping to “hear” the position of the correct answer. The guide can also use gestures for “visual learners.” Tearing up paper works, Mukhopadhyay said, as both an auditory and visual prompt. “Soma moves quickly from having the student choose from two choices to three or more, from picking up pieces of paper to having the student point to the answer, and then to pointing to letters to spell the answer,” reads the explainer on HALO’s website.
The process can sound innocuous, if a little chaotic, but the Encyclopedia of Autism Spectrum Disorders says that RPM prompts have, at times, taken on more punitive forms. Sometimes, the encyclopedia says, these include “verbal reprimands, trial termination, physical redirection, slapping or shaking the letter board against the subject’s face or chest, and blocking escape by positioning the subject between the table and walls.”