“This is what we know, when you tell us of your fondest hopes and dreams for us: that your greatest wish is that one day we will cease to be, and strangers you can love will move in behind our faces.”
Jim Sinclair, Don’t Mourn For Us
High Functioning Autism: Difference or Disability?
Dr. Simon Baren-Cohen wrote a thought-provoking paper in 2000, called “Is Asperger’s syndrome/High-Functioning Autism necessarily a disability?”
He proposes that autism be seen as a difference, and not a disability.
Different countries and societies need autism advocates to continue to speak out against prejudice toward autistics.
At the same time, it’s important to note the need to support those whose differences make it hard to function in a society that values social communication.
High Functioning Autism Defined
Although high functioning autism is a very common term, it’s never had a very strong definition. Prior to 2014, high functioning autism was a way to refer to autistics with an average to above average IQ. From 2014 forward, if we look at the new definition of autism proposed by DSM 5, we see that high functioning autism would means that a person needs minimal support to function in relationships or at work.
High Functioning Autism Characteristics
High Autism Characteristics versus Disability
Dr. Barron-Cohen, in his article, “Is Asperger’s syndrome/High-Functioning Autism necessarily a disability?“, shares the following observations of children with Aspergers and high functioning autism:
- The child spends more time involved with objects and physical systems than with people (Swettenham et al., 1998);
- The child communicates less than other children do;
- The child tends to follow their own desires and beliefs rather than paying attention to, or being easily influenced by, others’ desires and beliefs (Baron- Cohen, Leslie & Frith, 1985);
- The child shows relatively little interest in what the social group is doing, or being a part of it (Bowler, 1992; Lord, 1984);
- The child has strong, persistent interests;
- The child is very accurate at perceiving the details of information (Plaisted, O’Riordan & Baron-Cohen, 1998a; Plaisted, O’Riordan & Baron-Cohen, 1998b)
- The child notices and recalls things other people may not (Frith, 1989);
- The child’s view of what is relevant and important in a situation may not coincide with others (Frith, 1989);
- The child may be fascinated by patterned material, be it visual (shapes), numeric timetables), alphanumeric (number plates), or lists (of cars, songs, etc.);
- The child may be fascinated by systems, be they simple (light switches, water taps), a little more complex (weather fronts), or abstract (mathematics);
- The child may have a strong drive to collect categories of objects (e.g., bottletops, train maps), or categories of information (types of lizard, types of rock, types of fabric, etc.); and
- The child has a strong preference for experiences that are controllable rather than unpredictable.
High Functioning Autism Characteristics as per the DSM-5
As per Wikipedia,
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, abbreviated as DSM-5, is the 2013 update to the American Psychiatric Association’s (APA) classification and diagnostic tool. In the United States the DSM serves as a universal authority for psychiatric diagnosis. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.
Remember that the DSM-5 is based on a medical model that diagnoses disorders and accompanying signs and symptoms. In that context, DSM-5 lists the following characteristics:
- Delay in motor skills
- Difficulty interacting with others
- Difficulty understanding abstract uses of language, such as humor, or give and take in a conversation
- Obsessive interests in specific items or information
- Strong reaction to textures, smells, sounds, or sight or other stimuli that others might not notice, such as flickering lights.
- Difficulty identifying and expressing feelings
- Hand flapping
- Speaking without emotion (this only appears the case from observing facial expressions – in actuality, an autistic may actually feel more deeply than the average person)
The info graphic above [photo credit courtesy of the CDC]illustrates the challenge of using the term “high functioning”. While IQ is always average to above average, to superior, every single person has varying difficulties with social interaction, communication, behaviors, sensory issues, and motor issues.
“The difference between high-functioning and low-functioning is that high-functioning means your deficits are ignored, and low- functioning means your assets are ignored.” Laura Tisoncik (from Circle of Moms blog)
As the quote above illustrates, even though a person may have “high functioning” autism, this person may need help to address any one of domains on the left.
High Functioning Autism versus Aspergers
Before the DSM-5 revision, Aspergers was considered to be a distinct type of autism. The main difference separating Aspergers from high functioning autism was speech. For Aspergers to be diagnosed, there could be no delays in acquiring language from an early age. However, both Aspergers and autism children struggle with understanding the social context of speech.
Many researchers in other parts of the world, including Dr. Tony Attwood, disagree with DSM-5’s elimination of Aspegers from their terminology.
High Functioning Autism Diagnosis
Please read these articles I’ve written about Aspergers and high functioning diagnosis:
High Functioning Autism Treatment
The question becomes, “What are we treating, and why?”
In my opinion, autism is a condition and a difference, not a disease to be cured. So I don’t believe in treatment as a “cure” for a condition.
However, adults with Aspergers often experience stress in society because of their differences.
Living with autism is different, and adults with high functioning autism/Aspergers deserve just as much help as any other person.
Ideally, professionals who understand autism spectrum conditions in-depth can give coaching and cognitive behavior therapy to aid with understanding social communication, self-awareness, and executive functioning.
My article, Science Finds Effective Adult Aspergers Treatments, summarizes the current landscape of interventions for high functioning autism adults.
High Functioning Autism Books
- Asperger’s on the Job by Rudy Simone
- You Mean I’m Not Lazy, Stupid or Crazy?! by Kate Kelly, Peggy…
- Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment… by
photo credit: adamflip