What does it mean to be "high-functioning"?
High-functioning autism describes level-1 of an autism diagnosis in which a person has minimal to no major intellectual disabilities, but they may have difficulty communicating with others, expressing emotions, and interacting with others.
It may be easier for those diagnosed as high-functioning to interact with their environment as they may be able to:
- Obtain and retain a job
- Develop and maintain relationships
- Communicate effectively
- Self-manage maladaptive behaviors and emotions
The above behaviors allow many people with level-1 ASD to blend in with a neurotypical culture. As a result of these abilities, it is common for people with high-functioning autism to not receive an official diagnosis until later in life.
Difference between high functioning autism and aspergers syndrome
When the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was published in 2013, the American Psychiatric Association merged all autism-related disorders, including Asperger's syndrome, under the umbrella of ‘autism spectrum disorder’ (DSM-V).
Individuals with Asperger's syndrome display certain symptoms that are similar to those of, but may not experience delays in:
- Linguistic use and development
- Evolution of cognition
- Age-appropriate self-help/daily living skills
- Adaptive behavior development
Individuals diagnosed with Aspergers have milder symptoms that may be less likely to interfere with their everyday lives. However, high-functioning diagnosed individuals may show the same ability or skill deficits as those with Aspergers.
What are the different stages of autism spectrum disorder?
- Level 1: Individuals who may need minimal support in the development and maintenance of appropriate daily living, self-care, behavior management and social skills. Maladaptive behaviors for those with a level-1 diagnosis may be minimal and non-disruptive to their daily routine or others.
- Level 2: Individuals who may need more support to develop communication, social, play, daily living, self-care and behavior management skills. Maladaptive behaviors for those with a level-2 diagnosis may be more severe and interfere with their and others daily routine.
- Level 3: Individuals who need extensive support to develop communication, social, play, daily living, self-care and behavior management skills. Maladaptive behaviors for those with a level-3 diagnosis may be severe to include increased aggression or self-injurious behaviors. Skill deficits for a level-3 diagnosis will also be greatly increased.
What factors go into determining the severity of autism?
Autism is often diagnosed through a variety of assessments done by a psychologist with specific expertise in Autism Spectrum Disorder. The following are some of the most often used diagnostic tools for autism:
- The Autism Diagnostic Observation Schedule (ADOS)
The ADOS is a systematic examination of an individual's social interactions, play, communication, and restricted/repetitive behaviors to evaluate if they fit the criteria for autism spectrum disorder. This test is referred to as the "gold standard" for an autism evaluation and is used for children and adults.
- The Autism Diagnostic Interview, Revised (ADI-R)
This is a seven-question structured diagnostic interview for people with autism. The ADI-R is used to evaluate autism aged four and above.
- The Autism Spectrum Rating Scale (ASRS)
The ASRS is a questionnaire that assesses a child's autism level. The ASRS relies on observational data from parents and teachers and can be used for people from ages one to 18.
Challenges faced by children with high functioning autism
- Sensory issues
Sensory processing affects many individuals who have autism. Even for someone with high functioning autism, loud noise, large crowds, bright lights, strong tastes, or odors, as well as being touched, can be overwhelming or painful. It may be difficult for someone with sensory issues to go to restaurants, theaters, or shopping malls.
- Uncomfortable in social situations
Children and adults with high-functioning autism may have a difficult time reading verbal and non-verbal social cues They may not know:
- How to greet others properly
- When to let someone else speak and when to listen
- When and how to control their tone of voice and volume level
- When or how to start or end a conversation
- Depression and anxiety
High functioning autism frequently co-occurs with anxiety, depression, or other mood disorders. Individuals with such challenges are more likely than the general population to struggle with and receive a diagnosis for mood-related issues.
- Issues with executive planning
Executive functioning is a problem for most people with high functioning autism. Executive functioning refers to the abilities people have that enable them to organize and arrange their daily activities. This might make it difficult to manage a family or to adjust to modest changes in school or job schedules.
- Dysregulation of emotions
People with autism may display a wide range of emotions. This could appear as over or under reactions when something unexpected happens, i.e., transitioning from one place or activity or responding inappropriately at times (laughing during a sad story).
6. Difficulty communicating verbally
Verbally communicating with others can be difficult for those with high-functioning autism. This is because they may struggle with social cues or talking about unpreferred topics. Sarcasm, analogies, idioms, and other "pragmatic language" may also be difficult to comprehend for someone with high functioning autism.
Treatment for high-functioning autism
Occupational therapy, physical therapy, and talk therapy are all alternatives for autism treatment. However, Applied Behavior Analysis (ABA) is commonly regarded as the "gold standard" of autism therapy.
Approximately 70% of individuals with autism have at least one comorbid diagnosis, such as Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depression, or bipolar disorder, therefore it may be beneficial for one to receive a psychological evaluation to determine what other diagnoses they may have. This information aids in determining the best course of treatment.
Stigma and autism
Much of the language around autism focuses on deficits and challenges, and this deficit-based language increases the stigma. In reality, autism can be seen as a gift to include distinct cognitive talents that have been linked to those who have this spectrum disorder. Research has indicated that a strengths-based approach to therapy can be successful and help alleviate feelings of shame in individuals with autism and their families.
The phrase "high-functioning autism" minimizes the difficulties that many people with this diagnosis have in managing their daily lives. Although there is still much to learn about autism spectrum conditions, communication about these conditions, levels, skill excesses and deficits should provide the individual and their family with respect and dignity.
Songbird is a technology-enabled, in-home ABA therapy provider. We are raising the bar for children with autism by creating a future where every child can receive world-class care, tailored to their specific needs. Contact us today to start receiving life-changing autism treatment in weeks rather than months.