Is “High Functioning Autism” Useful, or Not?

No great advance has been made in science, politics, or religion without controversy. Lyman Beecher. If the quote above is true, then we have room for advancing our understanding of the term, “high functioning autism“, given the amount of controversy the term generates! I ran across this article about a month ago, called “What’s the Difference […]

high functioning autism debate

7 Free Parenting Tips for High Functioning Autism

  I remember how excited my wife Vicki and I were when her birth pangs started for our first child, David. Four days later, after two false alarm trips to the hospital, Vicki finally gave birth to David.  The whole week was exhausting, and David was born around 4 am. The staff at Evanston Hospital […]

parenting tips

How To Stop Procrastinating

“Procrastination makes easy things hard, hard things harder.” Mason Cooley It’s easy to rip a sheet of paper in half.  But place one hundred sheets of paper together, and you’ll have a very hard time cutting that stack of paper in half. Just as it’s easy to rip one sheet of paper, procrastination is like […]

how to stop procrastinating

High Functioning Autism

“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.”

high functioning autism

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:

  1. The child spends more time involved with objects and physical systems than with people (Swettenham et al., 1998);
  2. The child communicates less than other children do;
  3. 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);
  4. The child shows relatively little interest in what the social group is doing, or being a part of it (Bowler, 1992; Lord, 1984);
  5. The child has strong, persistent[2] interests;
  6. The child is very accurate at perceiving the details of information (Plaisted, O’Riordan & Baron-Cohen, 1998a; Plaisted, O’Riordan & Baron-Cohen, 1998b)
  7. The child notices and recalls things other people may not (Frith, 1989);
  8. The child’s view of what is relevant and important in a situation may not coincide with others (Frith, 1989);
  9. The child may be fascinated by patterned material, be it visual (shapes), numeric timetables), alphanumeric (number plates), or lists (of cars, songs, etc.);
  10. The child may be fascinated by systems, be they simple (light switches, water taps), a little more complex (weather fronts), or abstract (mathematics);
  11. 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 
  12. 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.

high functioning autism signs and symptoms

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:

Diagnosing Autism and Aspergers in Adults 

Here’s A Secret That Can Bring Aspergers Peace of Mind

Online Test for Aspergers and Mild Autism

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.

High functioning autistic adults often struggle with co-morbid conditions of anxiety, depression, bipolar disorder,  and obsessive compulsive disorder.

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

Or use this link to search for high functioning autism books on Amazon.

photo credit: adamflip

High Functioning Autism and ADHD

Howie Mandel, Michael Phelps, Solange Knowles, Ty Pennington, James Carville, Christopher Knight, Richard Branson, and thousands of other adults struggle with ADHD.

aspergers and adhd

According to one study, high functioning autism and adhd occur in up to 1/3 of children.  Therefore, it follows that many autistic adults struggle with ADHD.

Attention Deficit Disorder Explained

Attention Deficit Hyperactivity Disorder presents in a pattern of behavior present in multiple settings (e.g., school, home, work), that significantly interferes in social, educational or work settings.

Attention Deficit Disorder can be characterized by either inattention primarily inattention, or by both inattention and hyperactivity/impulsivity.

Here are some examples of behaviors –

Symptoms of Hyperactivity

  • Feeling like one is driven by a motor
  • Restless
  • Cannot sit still
  • Always on the go

Symptoms of Poor Attention

  • Easily distracted
  • Difficulty organizing
  • Becoming bored easily
  • Difficulty switching from one task to another
  • Difficulty planning
  • Difficulty concentrating
  • Can’t do boring or unattractive tasks

Symptoms of Impulsivity

  • Interrupting often
  • Answering questions before a person finishes asking them
  • Blurting out inappropriate comments
  • Acting before thinking
  • Doing things you later regret
  • Having difficulty waiting

In DSM-IV, ADHD could not be diagnosed as a separate condition if a person had autism spectrum disorder.  However, this is not the case for DSM-V.

However, a clinician needs be sure that ADHD symptoms do not occur only during the course of –

  • schizophrenia or another psychotic disorder
  • or that the symptoms are not better explained by another mental disorder, such as
    • depressive or bipolar disorder
    • anxiety disorder
    • dissociative disorder
    • personality disorder
    • or substance intoxication or withdrawal

Twenty years of research conclusively show that a significant number of people diagnosed with ADHD as children continue to experience the disorder as adults.

Here’s a video that better explains ADHD –


Diagnosis of Adult ADHD

Information from this section is adapted from the Mayo Clinic.

ADHD in adulthood has been a controversial diagnosis.  Psychiatric diagnoses, in general, are hard to validate.  With physical diagnoses, a doctor can perform a blood test, do an x-ray or biopsy, or even take a person’s temperature to confirm a diagnosis.  However, with psychiatric diagnoses, doctors must diagnose these conditions based on the patient’s report of symptoms, their own observation of the person, and the observations of others.

Who can diagnose ADHD?


As per Wikipedia, a psychiatrist is a physician who specializes in psychiatry. A psychiatrist specializes in the diagnosis and treatment of mental disorders. Psychiatrists are medical doctors who must evaluate patients to determine whether or not their symptoms are the result of a physical illness, a combination of physical and mental, or a strictly psychiatric one. In order to do this, they may employ the psychiatric examination itself, a physical exam, brain imaging (computerized tomography or CT/CAT scan), magnetic resonance imaging (MRI), and positron emission tomography (PET) scanning), and blood laboratories. Psychiatrists prescribe medicine, and may also use psychotherapy, although the vast majority do medical management and refer to a psychologist or another specialized therapist for weekly to bi-monthly psychotherapy.


According to Wikipedia, A psychologist evaluates, diagnoses, treats, and studies behavior and mental processes.[1] Some psychologists, such as clinical and counseling psychologists, provide mental health care, and some psychologists, such as social ororganizational psychologists conduct research and provide consultation services.

Family Doctors


Only Psychiatrists and Psychologists, and licensed master’s level clinical counselors or clinical social workers are likely to provide ongoing counseling.

The healthcare professional will rule out other possible causes for the ADHD – e.g., mental health disorders (anxiety disorders, mood disorders, adjustment disorders, learning and language deficits, psychotic disorders);  other health problems – thyroid disorder, lead poisoning, low blood sugar (hypoglycemia); or alcohol or drug abuse and  certain medications can cause ADHD-like symptoms.

The doctor may evaluate signs and symptoms from childhood.  S/he may ask for old school records and for information from teachers, parents, and anyone else who knew you when you were young.  Doctor may also ask to talk to your spouse, parent, close friend, or someone else who knows you well.

See also – 5 Easy Steps to Diagnosing Adult ADHD 

Here’s an Adult ADD Quiz you can take to find out whether you should seek a more formal diagnosis from a healthcare professional.

You may want to also have your spouse, a parent, or a close friend take it as if they were you (based on their observations of you), and compare the results.

The Effects of ADHD

The way we think and believe can worsen ADHD symptoms.

Behavior components are things that people do that can make ADHD symptoms worse.  For example, avoiding tasks or not keeping an organizational system makes leads to disorganization and procrastination.

Here’s a cognitive behavioral model of adult ADHD from  Mastering Your Adult ADHD.

high functioning autism and adhdCore neuropsychiatric impairments, starting in childhood, prevent effective coping.  Whether diagnosed in childhood or not, adults have been suffering with ADHD symptoms many years.  Distractibility, disorganization, difficulty following through on tasks, and impulsivity can prevent people with ADHD from learning or using effective coping skills.

Lack of effective coping can lead to underachievement and failures.  Because of this, people with ADHD have sustained underachievement, or things that they might label as ‘failures.’

Underachievement and failures can lead to negative thoughts and beliefs.  Growing up with failures can result in developing overly negative beliefs about oneself.  Consequently, when a person approaches a task, s/he may habitually engage in negative, maladapting thinking, that adds to avoidance or distractibility.

Negative thoughts and beliefs can lead to mood problems and make avoidance worse.  Thus avoidance and distractibility gets worse instead of better.

Treatment of ADHD

ADHD Meds often serve to lay the foundation upon which a house of skills is built. Without them can seem like trying to roof your house during a hurricane.  -Brian R. King

Medications are the first-line treatment approach for adult ADHD, and they are the most extensively studied.

A psychiatrist will first try stimulants, tricyclic antidepressants, monamine oxidase inhibitors (antidepressants), and atypical antidepressants.

Medications can reduce many of the core symptoms of ADHD: attention problems, high activity, and impulsivity.

However, up to 20 to 50 percent of people either don’t see a reduction of their symptoms, or they cannot tolerate these medications.  Even if they do respond to medication, they tend to see only a 50% reduction in their symptoms [Mastering Your Adult ADHD, pg 8}.

Cognitive Behavior Therapy

As seen from the diagram above, attention deficit disorder can lead to under achievement, unemployment or underemployment, economic problems, and relationship difficulties.  Medications don’t teach specific strategies and skills to cope with ADHD.

Cognitive behavior therapy is a psychotherapeutic approach which is time-limited, goal oriented, and will help you work ways to improve your organization and planning; reduce distractibility; think differently about yourself and your ADHD; overcome procrastination,; and prevent relapse.

If you’re interested in both diagnosis and treatment for adult ADHD, call the phone number on the back of your healthcare insurance card for behavioral or mental health.  Ask to be referred to either a psychiatrist or psychologist who specializes in diagnosing and treating ADHD.

Educate Yourself About ADD/ADHD


There are many attention deficit disorder websites out there, but I have been thoroughly impressed with ADDitude, the online add/adhd magazine.  This site has attention deficit information about ADHD symptoms, medication, treatment, diagnosis, and parenting ADD children from the experts at ADDitude magazine

Books About Attention Deficit Disorder

You Mean I’m Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder, by Kate Kelly

Here’s a book summary from Amazon:

With over a quarter million copies in print, You Mean I’m Not Lazy, Stupid or Crazy?! is one of the bestselling books on attention deficit disorder (ADD) ever written. There is a great deal of literature about children with ADD. But what do you do if you have ADD and aren’t a child anymore? This indispensable reference — the first of its kind written for adults with ADD by adults with ADD — focuses on the experiences of adults, offering updated information, practical how-tos and moral support to help readers deal with ADD. It also explains the diagnostic process that distinguishes ADD symptoms from normal lapses in memory, lack of concentration or impulsive behavior. Here’s what’s new:

  • The new medications and their effectiveness
  • The effects of ADD on human sexuality
  • The differences between male and female ADD — including falling estrogen levels and its impact on cognitive function
  • The power of meditation
  • How to move forward with coaching

And the book still includes advice about:

  • Achieving balance by analyzing one’s strengths and weaknesses
  • Getting along in groups, at work and in intimate and family relationships — including how to decrease discord and chaos
  • Learning the mechanics and methods for getting organized and improving memory
  • Seeking professional help, including therapy and medication

Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program, by Steven A. Safren, Susan Sprich, Carol A. Perlman, and Michael W. Otto

This program was developed by a group of psychologists at Massachusetts General Hospital and Harvard Medical School after treating adults with ADHD in their clinic, using cognitive-behavioral therapy.  The authors conducted a randomized, controlled trial, studying patients who had been treated with medications but still having significant problems.  Half of the patients received no treatment beyond medications; the other half took medications and also went through the cognitive-behavioral strategies listed in the workbook.  An independent assessor who did not know whether the patients had treatment or not evaluated their symptoms.  According to the assessments, patients who went through the program experienced about a 50% decrease in symptoms.  Those who did not had negligible changes.

If you are working with a cognitive behavior therapist, encourage her or him to purchase the therapist version of this workbook [Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Therapist Guide (Treatments That Work)].  Then work together through the material.

References Cited 

DSM V fact sheet

Aspergers Adults Symptoms and Signs Explained  

Mastering Your Adult ADHD.

Related Article:

Will You Help Me Free Yourself?

More Articles:

[widgets_on_pages id=”High Functioning Autism and ADHD”]

photo credit: Life Mental Health via photopin cc