I had the unique opportunity to observe the controversial Soma Mukhopadhyay, Executive Director of HALO (Helping Autism Through Learning and Outreach) in sessions with children with Autism over a three day span.
Soma employs RPM or rapid prompting method. Their website explains this method as “eliciting responses through intensive verbal, auditory, visual and/or tactile prompts”. According to HALO, “RPM is an empirical and rational teaching method,
based upon how the brain works.” Despite the claim of empiricism and rationalism,
there are very few mentions of RPM in the scientific literature. I was able to find references by Van
Ackers (2006) and a brief mention in a case study by Gernsbacher in 2004. Chen et al examined the effects of RPM on repetitive behavior in a 2012 study.
Before continuing, I must preface that I have minimal understanding/familiarity of RPM or HALO. I am familiar with facilitated communication, which entails learning to
communicate by typing on a keyboard or pointing at letters. The highly controversial aspect of facilitated communication is the involvement of a
combination of physical and emotional support.
Soma had been contracted with a small group of parents who paid for Soma and her son to fly from Austin, Texas to New Jersey to provide two 30-minute sessions each day to their children. One 5-member family has flown from out of-state to participate. There are several other parents of children with severe autism observing; they are devoted advocates of RPM and report impressive results.
Soma and her son are originally from south India. Tito (who is now a young adult) was diagnosed with severe Autism at 3; he is nonverbal but communicates independently with linguistic complexity (he writes eloquent poetry). His mother has been tenacious in her facilitation of Tito’s abilities and developing RPM. It should be noted that Soma does not have a psychological or
neurological background: she holds an undergraduate degree in
education and a master’s degree in chemistry.
In 2001, a grassroots group of parents in the United States influenced Soma to move to the United States and establish the non-profit HALO foundation. Soma and Tito’s story was the center of a 60 Minutes II report in 2003.
Parents and brief conversations with Soma revealed the following tenets:
- RPM is multi-sensory with the presumption that all children with Autism possess motor-planning difficulties. One mother described a “brain-body disconnect” claiming that all children with Autism do not have control over their bodies.
- Auditory processing difficulties do not exist in children with Autism. This, of course, goes against everything research points indicates and as an SLP, elicited an immediate negative visceral response.
- There are no prerequisite skills necessary to RPM. Complete cognitive competence is assumed.
- All responses should be elicited nonverbally, even if the child is verbal. It is thought that responses are facilitated by eliminating the complexity of verbal motor planning.
The children that Soma worked with over the three days ranged in age from 10-20. All could be described as having severe autism. All were nonverbal; all were in special education settings with one-to-one aides or homeschooled. None of the children have received RPM intervention but have been exposed to ABA and augmentative communication devices.
Here are some observations from Soma’s sessions today:
- The children are seated in a corner with a table in front of them. Soma stands to their right. This is intentional and explained “to help arouse the left side of the brain”.
- Soma speaks continually and quickly. Her sentences are complex. Her delivery is narrative in nature, weaving stories and tales, interjected with questions and choices.
- Her soft voice and affect are flat. There is no inflectional variation in her voice, her face is expressionless.
- She moves her hands rapidly, gesturing and moving her simple materials (stencil boards, paper, tape).
- When Soma asks questions, she prompts response with verbal and tactile cues. At times, Soma writes choices on pieces of paper that she tears at the
time of use. Again, this is intentional and serves as an “auditory
cue”. At other times, she holds up a simple alphabet stencil board. She places a pen in the child’s hand and asks them to spell out their response by pointing.
- The child does not need to extend their arm significantly, as Soma holds the response board close, making movement minimal. Again, this is explained as intentional to ease motor planning.
- Soma only provides a choice of two responses with every question (“Is an
owl a reptile or a bird?”). I notice that the correct response is often the second stimuli.
- Her continual, rapid-fire verbal and tactile prompting scaffolds the response. Soma encourages the child to point, cueing sounds and moving the board to position the correct response close to the pen.
- There are no tangible reinforcements for responses or to control behaviors.
- When a child exhibited stimulatory behaviors involving the hands, Soma placed a piece of tape on one hand and held the other by the wrist. In all instances the tape garnered the child’s attention and stopped the stimulatory behavior.
Here are some impressions and concerns of Soma and the RPM methods:
- RPM regards every child as possessing intelligence that includes comprehension of complex language. The auditory channel is also presumed to be intact. As an SLP, this raises serious concerns.
- RPM requires exhaustive implementation, usually by a primary caregiver. The implementer must be cued into extremely subtle motor movements. This raises the concern for the ability of skills to be generalized among people and contexts. The parents I spoke with are their child’s facilitator and implementation with other people has not occurred.
- RPM does take into account the sensory system and motor planning and makes accommodations for these difficulties.
- RPM asserts that academics should be addressed before interpersonal communication. Another area of disagreement with SLPs.
- I am happy to report that Soma did not recommend that other therapies be discontinued. All parents I spoke with were extremely critical of ABA, feeling that their children were not challenged academically or taught at all.
- Of course the lack of research into the efficacy of RPM–or even data collection of any kind–raises serious concerns. Unfortunately, it’s effects can only be characterized as anecdotal. For the parents I spoke with, that was enough for them.
Do you have any knowledge or experience with RPM or any other facilitated methods? If so, what are your impressions?
Chen, G.M. et al (2012). Harnessing Repetitive Behaviors to Engage Attention and Learning in a Novel Therapy for Autism: An Exploratory Analysis. Frontiers in Psychology, 3:12.
Gernsbacher, M. A. (2004). Language is more than speech: A case study. Journal of Developmental and Learning Disorder, 8, 81-98.
Van Acker, R. (2006). Outlook on Special Education Practice. Focus on Exceptional Children, 38(8), 8-18.