The Pitfalls of Presumptions Two AAC clinicians explore how the “presumed competence” framework can lead to problematic communication system selection. From My Perspective
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From My Perspective  |   December 01, 2018
The Pitfalls of Presumptions
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Augmentative & Alternative Communication / From My Perspective
From My Perspective   |   December 01, 2018
The Pitfalls of Presumptions
The ASHA Leader, December 2018, Vol. 23, 10-11. doi:10.1044/leader.FMP.23122018.10
The ASHA Leader, December 2018, Vol. 23, 10-11. doi:10.1044/leader.FMP.23122018.10
In this age of social media and increased connectivity, we have noticed several buzzwords dominating the vocabulary of clinicians and family members of people who use augmentative and alternative communication (AAC). We worry that these buzzwords and popular trends are quickly seen as the standard of practice, even if they are not rooted in sound evidence.
In particular, the phrase “presume(d) competence” has become an anthem for many clinicians working with people who use AAC.
Although it’s difficult to find a universally agreed-on definition for the term, it’s generally seen as an approach that assumes the communicator has significant untapped cognitive-linguistic capacities. In some instances, this philosophy is used to a client’s benefit—for example, to appropriately justify increased opportunities and access to communication tools for someone with complex communication needs.
Conversely, we have seen it used to a client’s detriment—to rationalize the recommendation of systems/tools that are not appropriately matched to the client’s motor, sensory and linguistic profile, or to the client’s zone of proximal development (tasks a client can’t do alone but can achieve with help).

If the AAC system is too challenging, the client is not likely to experience the success that we know fosters language growth.

Back to the beginning
The term “presumed competence” is rooted in an era when IQ scores were used as a direct measure of ability, mass institutionalization was common, and there was generally a deficit-focused perspective on disability.
In AAC, the push to presume competence may have developed in response to the use of the candidacy model, which requires “proof before progress”—that is, requiring learners to demonstrate their abilities before being offered access to tools and strategies. We now know that this model is not appropriate, and that to demonstrate skill, people must first have access to appropriate tools, strategies, opportunities and instruction.
The presumed competence conceptual framework appears to have emerged from Anne Donnellan’s 1984 article “The Criterion of the Least Dangerous Assumption,” published in the journal Behavioral Disorders. Although she does not specifically mention “presumed competence,” Donnellan notes, “In the absence of conclusive data, educational decisions should be based on the assumptions which, if incorrect, will have the least dangerous effect on the student.”
The actual term “presumed competence” was first used by Douglas Biklen in his 1990 Harvard Educational Review article describing and promoting facilitated communication. Biklen is an originator and a leading proponent of facilitated communication, a practice that has been discredited in two ASHA position statements (1995, 2018). In fact, Biklen uses the phrase frequently throughout his published works, including his 2006 article in Equity and Excellence in Education, “Presuming Competence.”
Evidence of merits
We challenge the conceptual framework of “presumed competence,” but please note: Thinking critically about presumed competence does not mean that we presume incompetence. In their 2015 article in Education and Training in Autism and Developmental Disabilities, Jason Travers and Kevin Ayers note there is a “false dichotomy that failing to embrace [presumed competence] means non-subscribers must believe students are inherently and therefore eternally incompetent.”
In fact, as clinicians, we should make no presumptions at all. Rather, we should provide opportunities and then let the data, the science and the client drive our clinical decision-making.
We found no results in our comprehensive literature review for evidence that “presuming competence” promotes communication abilities or preserves the dignity of the communicator. That said, we also wanted to be sure that we were not dismissing any merits to aspects of the concept.
There is literature indicating that teachers’ beliefs about their students’ abilities was the strongest influence in teachers’ willingness to implement AAC—and conversely, if a teacher perceives low ability, willingness to implement AAC decreases (see sources below). Several other studies cite negative attitudes as a major factor in decreased communication opportunities (see sources).
These studies certainly support having an open mind, high expectations and positive attitudes when working with people who have complex communication needs—but they do not support making clinical decisions without supporting evidence.

Mismatch in initial AAC system selection can lead to an underestimation of individual skills.

When presumption backfires
In our clinical practice, we have seen “presumed competence” used to justify inappropriate AAC system selection—for example, when a clinician prescribes a specific system based solely on a diagnosis (such as Rett syndrome, autism or Angelman syndrome). In many of these instances, the results are slow progress, underestimation of skills, missed time and opportunities, and for some, total system abandonment.
A client with an inappropriate system may not make progress or have the opportunity to demonstrate their true abilities because the system does not capitalize on their strengths. Additionally, mismatch in initial system selection can lead to an underestimation of individual skills. If the system is too challenging, the client is not likely to experience the success that we know fosters language growth. If the system is too limited, the client can’t achieve communicative potential.
When communication systems are selected based on presuming competence, and not on a clinical feature match and functional trial, presuming competence is not—to use Donnellan’s term—the “least dangerous assumption.” In fact, we have seen real harm in selecting the wrong system or strategy.
After exploring presumed competence, we conclude this philosophy lacks supporting evidence and may also have truly negative consequences. We recognize that clinicians often have good intentions when they use the term and subscribe to the philosophy. We do, however, take pause at the term’s origin in the facilitated communication literature, and believe it is particularly timely to critically examine our approach to evaluation and intervention.
As clinicians, we have the knowledge and access to resources that allow us to select tools based on the client’s current abilities and future needs. We don’t need to rely on presumptions about a person’s abilities—instead, we can use thoughtful, evidence-based system selection to reveal each client’s abilities and potential.
It is possible—and critical—to make data-driven, evidence-based clinical decisions, while also believing in and supporting the communicative potential of every person with complex communication needs.
Sources
American Speech-Language-Hearing Association, . (2018). Facilitated communication [Position Statement]. Retrieved from www.asha.org/policy/
American Speech-Language-Hearing Association, . (2018). Facilitated communication [Position Statement]. Retrieved from www.asha.org/policy/×
Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs. Baltimore, MD: Brookes.
Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs. Baltimore, MD: Brookes.×
Biklen, D. (1990). Communication unbound: Autism and praxis, Hospital practice, 27(4), 209–212, 214–216, 225, 228–229, 232–233, 235–240, 243, 247–248, 250. [Article]
Biklen, D. (1990). Communication unbound: Autism and praxis, Hospital practice, 27(4), 209–212, 214–216, 225, 228–229, 232–233, 235–240, 243, 247–248, 250. [Article] ×
Biklen, D., & Burke, J. (2006). Presuming Competence. Equity & Excellence in Education, 39, 166–175. [Article]
Biklen, D., & Burke, J. (2006). Presuming Competence. Equity & Excellence in Education, 39, 166–175. [Article] ×
Donnellan, A. (1984). The criterion of the least dangerous assumption. Behavioral Disorders, 9(2), 141–150. [Article]
Donnellan, A. (1984). The criterion of the least dangerous assumption. Behavioral Disorders, 9(2), 141–150. [Article] ×
Johnson, J., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success versus abandonment of AAC. Augmentative and Alternative Communication, 20, 85–99. [Article]
Johnson, J., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success versus abandonment of AAC. Augmentative and Alternative Communication, 20, 85–99. [Article] ×
Soto, G. (1997). Special education teacher attitudes toward AAC: Preliminary survey. AAC Augmentative and Alternative Communication, 13, 186–197. [Article]
Soto, G. (1997). Special education teacher attitudes toward AAC: Preliminary survey. AAC Augmentative and Alternative Communication, 13, 186–197. [Article] ×
Travers, J., & Ayres, K. M. (2015). A critique of presuming competence of learners with autism or other developmental disabilities. Education and Training in Autism and Developmental Disabilities, 50(4), 371–387.
Travers, J., & Ayres, K. M. (2015). A critique of presuming competence of learners with autism or other developmental disabilities. Education and Training in Autism and Developmental Disabilities, 50(4), 371–387.×
Zangari, C., & Kangas, K. (1997). Intervention principles and procedures. In Lloyd L., Fuller D. & Arvidson H. (Eds.),. Augmentative and Alternative Communication, (pp. 235–253). Boston, MA: Allyn & Bacon.
Zangari, C., & Kangas, K. (1997). Intervention principles and procedures. In Lloyd L., Fuller D. & Arvidson H. (Eds.),. Augmentative and Alternative Communication, (pp. 235–253). Boston, MA: Allyn & Bacon.×
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December 2018
Volume 23, Issue 12